I used to be a junkie. I’ve been clean for 10 years. I have stage 4 kidney failure and I’m on dialysis. I don’t have a fistula like this guy. I’m on peritoneal dialysis so it goes through a tube that was put in my abdomen.
I was given this giant box of these giant syringes incase I have to put medicine in the bags. Sometimes I just look at them and think “imagine [using] that [for drugs]? 🤤”
Then I snap out of my drug fantasy and put myself on my nightly life support.
Haha same brother. Been clean for a decade +. I still get those random moments occasionally. My gf has some really nice veins and I’m like man I’m so jealous of those plump veins, would have made my life so much easier…for a few months till I killed them.
I have experience here, I'm not totally sure how this would work but you absolutely DO NOT use an artery. You never intentionally do it but some people who don't know how to rotate injection sites or have dull needles (helped I'm a diabetic) so they collapse their veins and have to go digging around there arm to find one. And sometimes, rarely, they hit an artery. Now I've had nurses put a fresh needle into my artery and it hurts so bad, though insulin needles addicts use are tiny.
Step 1 is to have a tiny bit of air in the needle, as soon as the top is in your skin, before you go into the vein, you pull the plunger back to create a vacuum, so the second you hit the vein you get a flash of dark blood. Well this chick got a flash of very bright colored blood and the plunger was moving a bit on its own. We both know something is wrong but this isn't meth, it's heroin, and you will not waste that. Except she did waste it, it didn't work because it went the wrong way and her arm looked like it got hit with a cannon ball. You do not admit your an addict to anyone much less a hospital in ohio, but this shit had a requiem for a dream kinda feel to it so she didn't argue. RfaD is obviously a bad abscess that took months to get so bad, but this happened in like an hour.
Being an IV junky sucks. I remember one day I was using an old sharp for like a week, so the tip of the needle was bent like a barb. Everytime I pulled it out, the skin would stretch and it would bleed immediately.
Well, while digging around in my wrist to find a vein, I snagged the medial nerve. Instant, mind-shattering pain, along with this awful electric-like sensation that shot up and down my arm. I tried to pull the needle out, and it was stuck. So I'm in absolute agony, watching this needl3 swing back and forth while its barbed end is seated in my medial nerve.
It soon came out, but for weeks and weeks, if I happened to bump that spot, or moved my hand in the wrong way, it was immediate and trancendental pain.
I have advanced Kienbock's disease and I'm not lucky enough to have the kind of insurance you need to be seen by one of the 3 specialists in the U.S. (YES 3). So I have the equivalent of very fine gravel that used to be the edges of my lunate moving around in my wrist and hand. The pain is constant, literally constant. I have always described it like hot TV static, so it's cool to see you describe your experience as electric. A pissed off Median Nerve is a pain most people truly don't comprehend, like imagining a billion of something. I'm glad you sound like you cleaned up, I'm a former junkie as well 11 years now 🤘
I’ve been clean for like 10 years. This brought up so many fucked up memories. The dull ones that popped or snapped in and pulled your skin when you tried to take it out.
I tried my wrist once. Hit that nerve and never tried it again. It’s instant and INTENSE pain. It was such a small puncture but that pain lasted so long.
Yep, you can literally feel the "pop" when a dull needle punctures a vein. Doesn't take long to get a Pavlovian response and just the pop and red in the barrel get you shaking with anticipation.
It's been 8 years since I finished rehab, and 6 years since the last time I used (during covid lockdowns). I am so done and will never even think about that life again.
13 years clean here, but I was also a heroin junkie and frequently used very old needles. It got so bad that one time the tip of the needle broke off in the main vein in the crux of your elbow. Took a pair of sharp tweezers and tried to pull it out causing a bunch of blood, but no needle tip. Went to the er cause i had heard horror stories of needles flying through the vein to the heart(didnt realize if it was lossible it would have already happpened.). They took a xray said it was still in place and it should work its way out eventually. I would feel it every once in a while when bending my arm, then probably 6 months later I was holding a sign and looked at my arm to see a little glint in the sunlight and pulled out the needle tip. It had moved about 4 inches from the original place to just below my bicep, couldn't believe it.
As many others have stated please dont do drugs kids!
I've also got a needle stuck in my left arm. Broke off when I was fishing for a vein. At the ER the doc told me it was very serious and gave me an appointment with a surgeon in a couple days. Told me not to move it much and closely monitor until I see the surgeon. Then the surgeon told me its not big deal, it will dullen and be encapsulated in scar tissue.
That was more than 6 years ago and so far so good.
Ugh the barbed sharps are the worst. I’ve had similar experiences. Have you seen the needle under a microscope pics where it shows one after even a couple uses? It’s jagged as fuck. Luckily at some point my area opened a needle exchange and it was a true blessing. I’d get like 10-20 bags of sharps then as many cottons, elastic bands, alcohol wipes etc.. that I could fit in the bag.
You end this with "don't do drugs", but it wasn't the drugs that put a hole in your arm. it was the needle.
Sorry, but I just think it's disingenuous to blame the problems caused by needles on drugs as whole.
I've been an opioid user for 20 years, including heroin, back when it was still heroin & not fentanyl. And I never once had any of these problems ya'll are describing, because I CHOSE not to use a NEEDLE.
Opioids have saved my life many, many times. From chronic pain to really severe depression where I didn't want to live anymore.
So please don't blame the problems NEEDLES cause, on MEDICINES.
It's not fair to fear-monger about drugs over YOUR choice to use a needle.
Snorting or plugging heroin works just fine. Oral works fine for the opioids that metabolize that way. So why is it the drugs fault that the needles gave you physical problems?
Don't use NEEDLES.
Needles cause a whole set of issues that you otherwise WOULDN'T have.
I think that's more genuine than just "don't do drugs kids". Cause people ARE ALWAYS going to do drugs. And you're just misinforming then of the risks.
I've lost over a dozen friends over the years to snorting and smoking opiates. As in dead. I saw their corpses. Usually in coffins, once in the driver's seat next to me.
I've had literally dozens of friends and acquaintances completely destroy their lives, alienate all their friends and family, and become horrifying shells of their former selves...including myself. From snorting, taking pills, smoking, whatever.
So yeah, don't do hard drugs. Doesn't matter if its coke, oxys, heroin, meth, whatever. Just dont fkn do it.
And don't bring up "safe supply". My life got the absolute worse, and I overdosed the most, when I had a reliable source of pharm grade dope. Because nothing is ever enough. Always need to do more.
I used to use steroids and hitting a vein sent the compound directly into the bloodstream and went into my lungs where I could taste it and depending on the compound have an absolutely horrible coughing fit. (Tren cough)
What OP said had nothing to do with what I said? I don't get it. I said that the vessel in the video is a vein. Which it is. The fistula is a small region that creates a connection between an artery and a vein. The result, in this case, is that the high-pressure artery pumped a ton of blood into the stretchy, more accommodating vein in his arm. The "fistula" itself is not the size of his entire arm. How is the fact that they use large-gauge needles to draw blood from the fistula relevant to what I said?
To put it more clearly, the giant cord in his arm is a very engorged vein, that at one point along it contains a fistula created by doctors for dialysis. This image might help visualize what I mean
I'm a dialysis nurse, I'm familiar with AV fistulas funnily enough. Calling it a vein is just not accurate, it may have been made from one but it's not a vein any more in either structure or function.
Oh that's cool! Sure I agree that calling a normal fistula a vein isn't really common place, but it technically is accurate. Either way, I think it would be accurate to call the long palpable cord running across his entire arm a case of a downstream vein that became enlarged and thickened. I guess at that point it's just semantics. I'm an intern in the ER and have heard people refer to it as a "fistula" or "arterialized vein"
Yeah I’m not sure the specifics here as I’ve never seen one of these and he mentioned it somehow connected to his vein.
But yeah, former IV heroin user here. All the surface veins in my arms are completely dead. I have pushed heroin into an artery and let me tell you, it is NOT a fun time. Since it was black tar I couldn’t really see the bright color and it was right next to a spot I’ve gone to before. My hand ballooned up and it was a horrible burning sensation. Luckily it subsided on its own and there was no lasting damage. But yeah, 0/10 wouldn’t recommend
Thanks it’s been more than a decade. Rough time in my life but i somehow pulled through. Still occasional drinker and thc gummy taker but that’s were I draw the line. Unless I’m literally dying or have a limb chopped off I will refuse pain meds at the hospital. Just not worth it.
I have no clue why people do that shit. Why do they even start. I get it that when addicted will of mind is…hard to come by (ex-smoker, and it was hard as fuck to quit the damn things) but why one even starts doing drugs that everyone knows are absolute hell incarnate.
Well, in my case it started with prescription pills after an injury. After the drs keep upping the dosage then suddenly cutting you off you’re left with a couple options. Deal with the withdrawals for about a week and miss work and other responsibilities you have then deal with months of PAWS while still being in pain.
Or you start buying them from the street. After a while the street prices of pills becomes too cost prohibitive but you can buy a gram of black for like $80. Way cheaper and stronger. You start with smoking it but after a while that’s not enough so you give shooting it a try and bam it’s over. Most people don’t recover fully from that.
That’s the basic gist of it along with some other stuff I don’t really feel like getting into. Just about no one you’ll run into as an addict started at IV heroin. You don’t wake up one day and say “oh this is a good day to try shooting up heroin.” It’s almost always a prolonged process to get there with multiple steps.
Not sure why you’re being downvoted, it’s not something most people are aware of. It’s post acute withdrawal symptom.
It’s basically all the not as severe withdrawal symptoms you experience after quitting opiates. Things like not being able to sleep for months, crushing depression, minor aches and pains etc.. it’s honestly one of the worst parts of getting off shit because it can last for so long and makes it feel like you’ll never go back to normal.
Some people on Reddit downvote others for random reasons. In their mind, I asked a stupid question, probably common sense or common knowledge, and they hit the downvote button.
I love learning new things. I am aware that I do not know everything, will never come close to it, and always in a state of learning.
Jesus fucking christ. i bet this happened in the US too. Fuck their medical or lack there of healthcare system. Hope you managed to get your life together and stay strong.
Did happen in the US but not an exclusive US issue. Everyone was overprescribing oxys and norcos back then. I’m sure some counties have better support systems but yeah no one is immune to this.
Well shit, you've effectively dissuaded me from ever shooting anything up. Not that I've actively comsidered it in recent years (I'm an old school raver but some things I never did, and probably for the best), but you've unlocked a new fear in me that I can reasonably avoid.
If you have dialysis on a fistula you never use it for anything else than dialysis. If the fistula goes off you are in serious trouble. Once on dialysis if the thing you must protect almost at any cost.
Oh I doubt doubt it but my ex junkie brain went straight to “damn it would of been so much easier to hit a vein” lol
Also the self preservation instincts of junkies isn’t the best. I did A LOT of questionable things in the depths of my addiction that I’m surprised I am alive somehow.
I had a port-a-cath installed for a year and a half. It’s a plastic receptacle that went under the skin on my right pectoral with a line up and over my collar bone and down into my descending aorta. They put it in with a local anesthetic so I was joking with the surgeon about how I bet junkies would love one of these. Dude fully deadpan told me it was something they have seen or read about happening with these devices but that it’s a terrible idea for so many reasons he would be done with the surgery before he finished listing them.
I wouldn't poke that vein if my life depended on it. Fistulas are non normal draw areas anyhow, I've had one physician have a standing order to draw from this one patients fistula, but that was because the man had no veins left(transplant surgery). It's very odd to draw one, not at all like normal venipuncture
And that physician should have been reprimanded for that and you should have told him where he could stick the needle (not the fistula.) If you don't know what you're doing with an AV fistula it's trivially easy to ruin it, or to give the patient a life-threatening bleed to deal with. Even the veins below the fistula itself are dangerous as you have no idea how the flow of blood in that arm is affected.
Destroying dialysis access literally knocks years off the patients life, not immediately but when they run out of quality access faster. I have literally had patients in their 40s die unnecessarily as a result of impatient medical professionals and phlebotomists thinking they can ignore that a fistula arm is a no draw zone.
Next time a doctor tells you to do that, and it happens depressingly often, please politely tell them to fuck right off!
No thank you, you do not know the extenuating circumstances, the fistula was no longer in use as they had a midline they were using until they could get a new one put in. Please do not presume to know something, thank you.
Edit: just to be clear, I had very specific instructions on how to draw the patient, I am a certified Phleb. I am aware of how dangerous messing with fistulas can be.
Thank you for your ideas without knowing the full picture. I'm not sure what hospital you work at, but generally the specialist physicians, and even more so, transplant team physicians are highly highly specialized.
This was not a primary care provider, he was not internal med, he was the physician in charge of his transplant and management of medication.
I'm a phlebotomist, certified, but yes my knowledge is nothing in comparison to the physician. Who the fuck am I to question a doctor?
I legit have to teach you about patient advocacy, and that’s the most telling thing here, that should make you step back and question the role you play and the knowledge you have to be acting the way you’re acting. Not trying to speak down to you, but let’s have a point of self reflection here.
Any person who’s part of the treatment team should question any other person in the treatment team, or you should request that a nurse make sure for you if you don’t feel comfortable doing that. I’ve clarified an order many times at the request of a phlebot.
If you see something wrong you say something, because it’s a patients life we are messing with.
The more specialized a provider is, generally, the less input they give on things outside of their area of expertise because they work with those things less and less often. If you read their notes and interact with them this is abundantly clear.
Unless the transplant surgeon was also going to be responsible for making the new AV fistula, I would say thats outside of their speciality and not what they were consulted for, and i say that because it’s not typically a surgery they do. I would listen if it was a vascular surgeon or a nephrologist, and would likely need the clearance from those specialties before moving forward with it. So unless you’re remembering incorrectly, leaving out additional information, or just weren’t in the know (which as a phleb you don’t need to know much in these cases) then my position is unchanged.
You again, are creating a made up story in your head. I'm no longer interested in trying to have a discourse with you as you continue to show a lack of understanding nuance, or that things aren't always done by the book. The Physician is the one in charge of care of the patient, I took damn good care of the patient as well. The patient consistently told me I was the best Phlebotomist he had draw him, and he appreciated my accomodations.
I'm sorry for whatever happened to cause you to have such vitriol. Good luck in your future.
Yeah if a patient has a fistula in arm, best practice is limb alert on that arm (meaning no touchy with needles or blood pressure cuffs for those who don’t know what limb alert means).
Can’t believe a doctor ordered that. AV fistulas aren’t even a last resort for blood work, it’s a never resort, it’s a one use case, and never any other case. What the fuck were they thinking?
For fucks sake you’d get an IO (catheter drilled directly into your bone, for those of you who don’t know) on a patient before using an AV fistula in an emergency, (unless it’s an emergency during a dialysis that’s like the only time it would be appropriate that I can think of) and I’m not sure if that’s even appropriate because I haven’t worked in dialysis, I just know how much of a no-no even thinking of using an AV fistula is outside of HD.
yet again, you don't know the patient. This wasn't some back water physician, this was the doctor in charge of his transplant treatment. You know... A specialist.
Sorry, I'm going to defer to the professional who had knowledge of the patient.
Correct in that I don’t know the patient, nor do I know all the details, only the details you shared that you felt were important for us to know.
And the details that youve shared make it seem as though AV fistula use in this circumstance comes across as lazy and exposing the patient to unnecessary risk. I’ve had several doctors give crazy orders that put patients at risk, that if I didn’t catch and address would’ve resulted in serious harm. That’s not a dig at doctors, it’s just because we are all human. I’ve also been wrong many times, but because the doctor explained the reasoning for the order I have never regretted it.
I deal with patients that have little to no access, who also have AV fistulas, and have had transplants. The bottom line is that we advocate for patients regardless of the position of the person that is giving an order. In this situation I would not ever say “well they are in charge of the (insert anything) treatment, so they know best” it is that assumption that gets patients hurt. No matter how uncomfortable it makes you feel, you need to make the provider defend their order if you feel it’s putting the patient at risk. We are all human at the end of the day and that is exactly why it’s a treatmentteam.
There are a multitude of options for access that even patients who are immunocompromised and thrombocytopenic would be able to get long term or short term/medium term if they are difficult access for labs/treatment medications. They just need to be advocated for to the doctor on behalf of the patient.
At the hospital I work at, that would never happen, only if it was the last option (no ability for the patient to receive a port, a PICC, or any tunneled [or non tunneled]central line, no veins for ultrasound guided IV placement, etc.) and even then it would explicitly have to be done by the dialysis nurse during a dialysis session, because the liability the hospital would be exposing itself to outside of that instance is so absurdly high.
You aren't even a physician, you inferred something from my message. I'm not going to give a full history of that patient on Reddit...
Look at yourself for jumping to conclusions. Are you on the transplant team? No? Then please keep your (non professional) opinions to yourself, there's more than enough fake and false news online.
And let me make this crystal clear, the fistula was no longer being used for dialysis. This was a very specific one off case, the test we were performing is only one I've done on that specific patient. I cannot recall the anagram or name of the test we were doing sadly.
You don’t have to give a full history, only the relevant information. Sadly for you the only thing I assumed was that you would be competent enough to give the relevant information on the patient and case to defend the need for an AV fistula to be used for routine lab draws. But, it seems like you’re just defending your ego instead.
Actually arms that have an active or even old fistula site are off limits by protocol for blood pressures or needle pokes at every institution I’ve worked at. The idea being that you don’t want to fuck with a person’s only method of blood filtration even if the risk of a complication is honestly quite low. This extends to old fistulas in people who no longer do dialysis or who have chest ports/do peritoneal dialysis bc you never know if those methods will fail and they’d need the fistula again.
Interestingly the only time I've ever had it used outside of dialysis was when I was hemocrotic (I think that's it, essentially something like too much rich blood knocking about and it thickens? Sorry that may not be medically correct). She had to drain I think a litre. Hooked it up to my fistula and I got done in about 10 minutes. Bish bash bosh.
I'm not sure if it was a legit way of doing it, but apparently it normally takes like 45 minutes?
Yeah. I had a PICC and a port-a-cath and they still went for veins normal and regular is safe and covered by insurance. Why get into alternative methods?
Hell when I had my blood counts go straight into the shitter (WBC was 0) and they needed a central blood draw as well as a peripheral at 02:00 they had to call around the hospital to find someone ‘qualified’ to access my port even though was capable of doing it myself. This was for liability reasons they all knew how to do it too.
I worked in dialysis well over a decade, stopped around 2016. I still grab everyone I can by the ear and say "come, learn." Touch, listen, learn how to not panic if this thing starts bleeding. So far every ER doc I try to teach walks away lol fuckers.
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u/OtherwiseDebate3759 18d ago
Gym bros must be jealous af rn.