But after two surgeries to create it, the upper arm fistula now has a robust "thrill" - that familiar vibratory sensation you feel when you lay your fingers across a healthy fistula. A "thrill" or "bruit" confirms underlying blood flow and turbulence. A fistula, after all, is created by surgically connecting an artery to a vein - to make that vein grow large enough and sturdy enough to accommodate a blood flow as high as 400 ml/min!
The Dialysis Team had agreed to initiate Steve's "virgin" fistula while he is still in the hospital. If this process went well, we could possibly leave the hospital without his internal jugular catheter (the central line in his neck). This would be enormously significant, as it would remove one more potential source of infection and simplify Steve's home care.
They also agreed to have me do today's puncture. If you haven't seen one, a 16 guage sharp needle looks like a speer. You can see down the inside of the barrel! Remember that a guage of 16 means it's one-sixteenth of an inch in diameter!
So, with nerves on notice, I injected two small wheals of lidocaine, and plunged in the two 16-guage needles. Success! The blood flowed easily, and the run went well. I believe that the process will come back to us - like riding a bike, sort of.
The best thing about all of this is that in Steve's somewhat extreme case, he will able to take advantage of all the positives of Home Dialysis:
- One person doing the punctures - me!
- The comfort of home
- The control of being at home
- No transportation to the kidney center (which we'd have to pay for out of pocket)
- No "institutional" risk of MRSA
- No exposure to technicians who may be less careful about their jobs (we know they are rare, but they do exist!
- Flexibility for our already stretched schedule
- More contact with friends and family who visit Steve during his treatments
- More frequent, gentler dialysis
- More effective dialysis
We are continually grateful to have Home Dialysis as an option. What a relief for our family! And what a true miracle this is!
Take care. Linda Gromko, MD