Friday, April 10, 2015

The high drama of self-cannulation

I've been inserting my own dialysis needles into my shunt for more than two years now. One would think I'm an expert by now. But each time it's a challenge. You have to push the needle past the skin into the shunt, but not too far in, or else you will go right through the lower wall of the shunt and into the muscle below it. At a certain point after insertion, you have to change angle so you can move along the inside of the shunt, and not hit the wall at the other end. All this is one smooth movement. In and turn.

I have had a nearly 100% success rate so far over the last two years. The first six months were hell, bloodbath after bloodbath, but I got good at it and could get it in nearly pain-free (unless I hit a nerve, but I gradually learned to avoid the bad spots).

But on Monday this week I made a huge blunder. I pushed the needle in just a little too hard, and it ended up deeply embedded into the muscle underneath. It doesn't hurt, but you hear a distinctive pop, which is the sound of the needle exiting the shunt from the other side deep inside.

At this point I lost my nerve; do I pull out the needle, and if so, how will I know that I'm out? Could I end up pulling it out entirely if I pulled too hard, and have a bloodbath on my hands? The nurse was standing by luckily, and he took over. It turns out you hear a distinctive pop when the needle exits the muscle on retraction. So the nurse expertly pulled it out just enough to get the needle correctly positioned and all was well...till the next morning. Now that a hole had opened up in the shunt, blood leaked out slowly all night into the tissue underneath, with the result that I developed a huge swelling around the shunt, so much so that I could not even see my shunt any more (at least not the part where I had done my mis-insertion). The visual impression of my shunt half disappearing really freaked me out.  It's the one thing that's keeping me alive and seeing it "gone" amid the swelling somehow really shocked me.

So much so that I didn't really have the nerve to insert my needles again on Wednesday, I had the nurse insert it. There wasn't much space left on my shunt to insert the needles, so the nurse stuck it into a fresh spot that had never been needled before, high up on my shunt. Very very painful! The skin on the upper part of the shunt was fresh and never punctured, so it had no hardened skin.  To make matters worse, I think the nurse inadvertently hit a nerve and so I was in pain all night. Amazingly, I managed to go to sleep, but I dreamt of being tortured by someone or the other.

Today's Friday, my last dialysis for the week happens tonight. Am I going to go back to inserting my own needles? We will see how much nerve I can muster. I must say, I feel like a total failure---so much for being a third degree black belt in Iaido! A needle insertion is very much like classical Japanese sword technique: you go in straight, with the sharp end of the needle, and you have to make a quick change of angle to make a sharp clean cut with the edge of the needle to enter the shunt. If you do this just right, there is not a trace of blood. I should be really, really good at this, I've been practising this movement for decades! I guess the problem is that there is so little room for error, it's happening at millimeter precision.

Dialysis is usually OK for me, I can live with it and it doesn't intrude into my life much any more, now that I do it overnight. But these incidents really mess up my life.