[RNinfamily]

I am not a dialysis nurse so if any of you could respond I would appericated.

My mother in law as a shunt that has developed scarring around it and the facility is have more and more difficulties access her shunt and it become more painful for her.

She has been on dialysis for about a year and this is her 2nd shunt since she started.

Is the scarring normal and can anything be done about it?

Thanks for responding

[chatty-rn]

Does she have a fistula or a graft?

[RNinfamily]

Thank you for responding.

She has a fistula.

[chatty-rn]

Are the staff rotating sites on the fistula? If they are going in the same area, it could cause a psuedoanuerysm and could get painful. maybe they need to do a fistulogram to check how well it's functoning. If it isn't a long fistula, doesn't have room to rotate, maybe it would be good to buttonhole it. Also, if they don't use lidocaine, maybe she could get an RX for EMLA cream to put on prior to acccessing. Hope some of this helps.

[RNinfamily]

Hi! Chatty Rn

They are rotating the sites because she has scarring/hard nodules alone the fistula.

I will have her inquire about using EMLA cream and if the are using buttonhole technique.

Thanks for responding.

[norcalidiot]

I worked as a PCT in a dialysis center and noticed the pts that used lidocaine injections rather than the cream or the spray had more problems with their fistula.

[RNinfamily]

It was suggested she see a dermatologist to "soften" the areas.

Has anyone heard of this and has this worked before?

[penem10]

I would not recomend going to a dermatologist to soften the areas. The scarring, if minimal is protective to an extent. The scar tissue will decrease the pain sensation to some degree.
I would recomend a fistulagram also, this way you know what you are dealing with. She may have a stenois of some sort.

[chatty-rn]

Hi, I don't agree with the dermatologist idea, but I think fistulogram to check it out and see if there are any problems that can be fixed before the fistula stops working. Good luck.

[RNinfamily]

Thanks Chatty-rn and Penem10 for replying.

We will check in to a fistulogram.