Hi Stuart,

Not sure if my question is in your realm or not, but Doesnt hurt to ask.

Here is my info:

Upper Arm Brachio Cephalic Fistula - Very Small Veins
Buttonhole Needles =16g
Blood Flow = 280
Time of Treatment = 4.5 hours
Fistula is almost 5 yeras old
Fistula is very snesitive to moovement
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Question...
My access is very sensitive to moovement and very positional with needles. At times, when starting treatment, venous pressure will start around 60-90's and arterial around 25-40. After a few minutes, the venous pressure does go down as it seems to settle down. I also know that I do have spasms.

At other times when the venous pressures start off high and stay high, I believe the needle is hitting against the wall of the vein since my veins are so tiny. I often prop the needle up and it does make a difference

There are also times after propping venous needle, they do not come down and as i go up on blood flow, the venous pressures also rises with it increasing blood flow. When this happens, I flip the venous buttonhole needle at beginning of treatment and the venous pressures go down instantly and the treatment is no problem.
No matter if I prop, or flip, the needles will settle down with a venous between 90-120 and arterial of 90-120 during length of treatment.

I sometimes flip the venous needle at beginning of treatment 3 or 4 days per week.
Again, i know my veins are small and willing to bet the needle is just hitting the wall and when i flip, it corrects the issue. Sometimes we just know by the stick that I am going to have an issue. When we do a good stick, no issues at all.
I tend to balance out with arterial pressures between 95-115 and venous of 90-120.

Should I be concerned and have a fistulagram? or it is ok the way I am doing things just by flipping the neelde? Since the pressures seem to bepositional and go down after I adjust, Im thinking that everything is ok and it just depends on the stick.

Any information/suggestions would be apprecieated..

///M3Riddler