Monday, June 10, 2013

Air in the needles

Day before yesterday I had just finished cannulating myself and was ready for the tech, Guruvulu, to connect the lines and start dialysis. I noticed that there were a few air bubbles at the beginning of my venous needle. I asked Guru to use a syringe and remove the air before connecting the line.

When he did that, he got frothy blood out! We were both surprised!

He discarded the frothy blood and tried again. Same thing. All he was getting was a mix of air and blood - in fact, more air than blood. This, when the needle was already inside the vein. He then tried the arterial needle. Surprisingly, he got a little air there as well. The second time he tried the arterial however, he got blood.

We wondered what the problem might be? Air could not come out from the needle because it was definitely in the vein. I use buttonhole needles and there is no way the needle could be in a wrong place because there is no sharp end to create a fresh path. Buttonhole needles have blunt ends and they are meant to slide through an established tract to go into the vein.

Where then could air be coming from? For a minute, I considered the possibility of air coming from within me. No, that was impossible! Even though some people might consider me a gasbag, this was taking things too far.

Guru and I concluded that the needle was defective. There was probably some crack somewhere which was causing air to enter it when we used a syringe to suck.

We decided to pull out both needles and not take any chances. So, we did that and waited for a while for the bleeding to stop. I then re-cannulated myself using the second pair of buttonhole sites (I alternate between two sites) and after a delay of about an hour, we got started on dialysis.

The next day, I discussed this with the other tech, Naidu (I have two techs alternating as well). He argued that if there was indeed a crack in the needle, blood would have come out from the crack once the needle went into the vein. That made sense. He suggested that the needle must have a clot somewhere and air was entering it through the 'eye'.

I am not really sure what caused the air to enter it. There is no explanation that seems perfectly logical. One thing I realized from this incident though is that it is important to push saline into both the needles before cannulation. This makes it easier to detect any problems in the needles before hand. Many people don't do this and lose out on an opportunity to detect such problems.

Whenever any such incident happens, for a moment, I think - is dialyzing at home worth the risks? What if the bubbles went undetected? Since this was the venous line, it could have proved fatal. Any air in the system can be detected only if it is caught before the Air Bubble Detector. After that there is no protective mechanism. I quickly dismiss the thought because I realize that if it were not for daily nocturnal home hemodialysis, I would have given up on life a long time ago. The freedom this modality gives me in terms of the ability to work full time, to be able to swim everyday and have practically no diet and fluid restrictions cannot be imagined on conventional dialysis, at least for me.

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