I experienced a problem that I have had in the past. I was wondering what or how others deal with it. This is what happened. I have a Fistula in my right forearm, it’s quite strong and tends to be quite tender. The nurse administered the lidnocaine which can in itself be very painful at times(sometimes it doesn’t hurt at all). Now I like to count to 40 before I want the 1st needle to go in, I feel safe that the insertion of needle will be painless. That wasn’t the case this time, it was like there had been no lidnocaine given. Now my dilemma is… When told “it’s ok it’s in, it’s in, it’ll settle” do I accept that even though I am trying not to cry and part of me wants to shout and it’s hurting like hell hoping it will ease but yet part of me is thinking of her and how she must be feeling causing me pain OR do I tell her to remove the needle knowing that’s going to extend the time of being put on and start all over again? And now she’s anxious, I am anxious and it’s all very tense. As it happened the 2nd needle also caused pain and had to be removed, all in all it took the best part of an hour to put me on. Now I aam in a quandary, I don’t want her to feel she needs to stay away from me, my trust in her is not broken but sometimes it is difficult or it is for me to be direct and state what is best for me. You’d think after 11 years of dialysis I’d have got this sorted by now!

6 thoughts on “Dilemma

  • Is it possible to use both Emla cream and lidocaine? If so, the Emla cream, which is applied sometime beforehand, may help with the pain.

    I do think that you should talk to the nurse, explaining what works for you and what doesn’t. Psychologically it is important that you control as many aspects of your care as you can.

    • Thanks for that Rob. I used to use the cream but found I didn’t like the numbness it caused to my fistula. This fistula is nothing like my old one, it so much stronger and extremely sensitive. What frustrates me is that there are times I don’t feel the lidnocaine at all, no prick, no sting nothing and that’s when I know everything will go smoothly. Other times it stings like a hornet, and then there’s the times when they miss where they have administered the lidnocaine but tell me ‘I went where the lidnocaine is!’ How can that be when it’s hurting. But I can’t say anything because I am upset and I just want the whole process over, but underlying everything is ensuring that the nurse is ok.

      • When I was dialysing at home, like you, if the lidocaine injection was painless the needling was usually painless. However, because my fistula didn’t develop too well, I used to dread needling the more sensitive areas of my arm.

  • If you are using the ladder technique and going in different areas, maybe try and see if it is in one particular area that it hurts, there is a good chance you have a nerve near it. Just a suggestion or maybe find a place you know it doesn’t hurt and start to buttonhole, using the same spot each time.

  • Lindsay. Try not to worry to much about the nurses feelings. I know where you’re coming from as I used to be just the same. However, after a while I did used to say if the needle was uncomfortable . After all it is our arm that the needle is in for four hours and I’m sure the nurse would speak up if she was a patient and in pain. Did they try reducing the pressures or turning the needle as I find this sometimes helps. I sometimes find the needle more comfortable with the bevel facing down. I have never used the lignocaine injection as I believe it is more painful than the Dx needles. Had it once for a suture. Never again. I used the lignocaine spray which was fine. Another option which is far less painful is to have a go at self needling. Far less pain as you know when the needle is in situ. I have had no ‘blows’ since being on home haemo and now don’t use any anaesthetic. The best anaesthetic I know.

  • I found that if you use EMLA cream with cling film it spreads over the arm too much and makes the whole area numb, I now use Mepore dressings and just put it on the area you needle it keeps it there and only a small area is numb. Try not to get large dressings, I use 10 x 11 cm and they work great or even slightly smaller depending on the size of the area you use.
    If you are feeling pain once the needle is in and it doesn’t settle down then they are not in right and you need to tell them. At the end of the day it is your arm and you are the one that is uncomfortable. Dialysis is not nice so anything that makes it a bit easier needs to be done.

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