How to put in your own dialysis needles

- from Theory to Practice, to the Real Thing

Some time or other, once you get used to the idea of dialysis being part of your life, you may
decide to start putting in your own needles.
Most commonly, this time comes when you begin home dialysis, where self-needling is
standard fare. But there are other reasons. It came for me after a particularly sloppy effort
from a new guy (new to my unit) who went through both sides of my fistula and didnt seem
to be all that bothered about it. Since it was my first blow, my emotions were at the other
end of the spectrum. After that, I felt more and more stressed before and during needling.
Finally I realised that if I was to ever relax again, I should take charge, and put in my own
needles. Like thousands of other BigD-ers around the world, I have never regretted it.
The DIY advantage
When a nurse or technician puts in your needles, they feel it from the outside, but only you
feel it from the inside. You know if the needle is positioned wrongly, brushing up against
the side of the fistula, pushing through the other wall, scraping along the bottom, or
otherwise not right; often they dont. If you Do It Yourself, youll have the whole picture,
from the outside and the inside.
Theory
The theory of needling is simple:
1. Find two wide or deep, unobstructed stretches of your fistula 4-5 cm (1.5 -2in) apart
2. Clean and disinfect the areas
3. If you use wet needles, fill the needle lines with saline, leaving the syringe attached
4. At each area:
Choose a clear entry point; holding the butterfly wings at the business end of the
needle, with the black dot facing up, push the needle through the skin and the
fistula wall. Once through you feel a slight bounce and you may see a small blood
pulse at the start of the tubing near the needle. At this point, you are through the
fistula wall, and into the fistula. Slow down so you dont scrape or pierce the
opposite wall of the fistula. Angle the needle almost parallel with the fistula and
slide it home, making sure to keep clear of any obstructions.
5. Tape it in place (if needed, add a little gauze wedge under the needle to hold it at the
right angle).
6. For the first few times, ask your nurse/technician to check the blood flows easily.
Wet needles (the needle is filled with saline): draw blood into the syringe and flush
the needles back and forth; it should flow readily, with minimal effort;
Dry needles (the needle is empty): undo the end cap to allow blood to flow to the
end of the needle tubing; again it should do so without delay.
7. Youre ready to go!
Just like riding a bike, the theory is pretty straightforward until you get to step 4, when the
needle hits the skin, so to speak. And like riding a bike, you cant learn to do it by reading
about it; only by doing it or at least practicing it.
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- Briefing #5
Practice
Tell the staff in your unit (ideally someone you know is an expert needler) that you want to
learn to needle yourself, and that you would like some advice and practice. Most will have
their own training technique they will be happy to share.
The simplest and most commonly suggested way to practice to get the feel of needling, is to
use real needles on an orange or lemon:
Using a new, sharp needle of the same gauge you use for dialysis, hold it at an angle
of about 45 degrees and push it through the lemons skin and pith. To get the angle
correct, use your middle, ring and little finger as a bridge (like you would when you
play snooker or pool) and do all the work with your first finger and thumb. You
should feel a small pop or release as the needle passes through the outer layer and
into the flesh of the lemon.









Once through, angle the needle almost horizontal and slide it home.









After some practice, you should be able to do this as a single fluid motion.
Practice taping it in place with your non-fistula hand.
If you had X-ray vision
Heres what needling looks like if your arm was transparent (or you have X-ray vision).











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Visualize
Finally, visualize it. Use this powerful mental technique to reinforce and strengthen your
minds ability to perform and master physical skills. You do it by recreating all the images,
sounds and feelings in your mind surrounding needling in order to practice in a perfect
environment.
Relax: Find a quiet spot where nobody will bother you, take a couple of deep
breaths, let go of all the tension, and close your eyes
Start imagining the environment: your chair, your fistula, its shape and feel, the
needles, the disinfectant, the gauze and tape, everything, until you have a clear and
defined picture.
Now imagine yourself coming closer. You have disinfected the sites. Pick up the
needle. Look at your hands and slowly add detail to the image. Look at how you sit
and hold the needle and your arm, always trying to add as much detail as possible.
Feel the needle in your hands, feel your fistula arm relax and focus on the entry
point and path the needle will take. Allow yourself to push the needle into the
fistula, just as you would do in practice. Imagine yourself needling, positioning,
taping and flushing without failing or stopping, just as if you were an expert.
Allow yourself to slowly come back. You have completed your practice and the image
slowly fades. When you feel ready, open your eyes again.
Know Your Fistula
Now you are confident you have a feel for needling and understand how it works, it is time
to get to know your fistula.
Take some time to explore your fistula in detail. Look at where others have punctured it
and work out why they chose those spots. Get to know it: how deep it goes, where the
bottom lies at each entry point, where obstructions like bends, narrowings and dips are,
where there are clear 27mm (1.1 in) runs for the needle (which is 25mm (1 in) long).
Also, work out how you will deal with the sting of needling. While the sting is short-lived,
you may decide to numb the area first with local anaesthetic to help reduce your stress
until you get more confident.
Also, the quicker you put it in, the shorter the sting (but dont rush it; take it steady).
The Real Thing
Ok, you have practiced to get the feel, and youve visualized it to embed the technique and
you have explored and got to know your fistula: time for the real thing.
Let your unit manager know that you wish to put your own needles in on the next visit.
They should have some kind of backup protocol that you wont need, but that is
unobtrusively in place.
Go through the routine a couple of times in your head on the way to the unit. Once there,
put it from your mind until you are settled and set up, ready to go. Then repeat the whole
process for real. No big deal, just the logical nest step of everything youve done so far.
Welcome to the DIY Needling Club!
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