PUNCTURED!!!

(art by Wally Wood)

Among the many things I hate about dialysis is the removal of the bandages after treatment. 

 Once one's surgically-created fistula has matured enough, the tubes that facilitate the dialysis process are connected to one's fistula forearm via two needles, one arterial and one venous, and as the fistula becomes more amenable to being penetrated, the gauge/size of the needles increases so that the hollow needles can more easily allow the flow of blood both into and out of the body. 

A simple diagram.

As this process removes, filters, and replaces one's entire blood supply, along with removing excess fluids/uria that one's kaput kidney are no longer capable of purging from the body, wide-gauge needles are slowly worked up to, and I am at the point where my regular needles are the big ones. Consequently, when the needles are removed at the end of a day's session, the entry points must immediately be tightly bandaged, lest the area quickly wind up looking like a scene out of BLOOD FEAST (1963).

When I get home from treatment, along with the usual puking and inability to eat anything until 11pm or later, I have to wait several hours, usually around five or six, before removing the day's bandages. When the nurses bind the wounds, they have to make them as tight as possible to prevent leakage, over which I wear a compression sleeve to aid the process, and sometimes the removal of the tape and wadding can be painful due to the glue on the tape adhering to well to my atopic dermatitis-scarred skin, and it can even take a chunk out of me when removed.

That said, when removing the bandages, I have to have strong over-the-counter bandages at the ready to deal with any possible spillage. Since the wounds are basically small holes, I generally favor Band-Aid Tru Stay Clear Spots, which are small adhesive patches just a tad smaller than a square postage stamp, which makes them the perfect unobtrusive bandages for the punctures in question. I also have a bottle of alcohol close by to further clean the area once the initial wrappings are off and before the Clear Spots are applied. The problem is that before the nurses wrap the punctures, they cover the fresh wounds with an individual medical band-aid each before applying the absorbent wadding and then tightly wrapping everything from there. Removing the medical band-aids requires a good grip, as the adhesive is strong, and when removed, any healing over is undone by ripping off the band-aid. The venous puncture is barely an issue, as it yields barely a pin-prick's worth of blood that's easily swiftly covered, but the arterial puncture can be a whole other ballgame.

It's there in the name: It's an artery. Therefore, once opened, the vino flows quite freely, Fortunately, it's a small puncture wound, but that does not stop blood from flowing quickly, no matter how prepared one is for the patching of it. I have to daub at the arterial site with dry medical wipes and hope that the flow slows long enough for me to apply a clear spot, but sometimes a clear spot just isn't enough and I have to cover the blood-soaked clear spot with the more aggressive and stretchy Band-Aid Water Block Tough Strips. As the name clearly states, these are durable items that stretch to allow the user to regulate the needed tightness of binding, in effect serving as a first aid answer to duct tape, and being perfect as a patch for an arterial site puncture.

I had this on my mind because I just got through changing out today's bandages (applied by the mighty Shaunda), and it was not a pretty sight. If I had not gotten quite skilled at this procedure over the past several months, my bathroom's surfaces would have ended up looking like a minor crime scene, and even with my relative adeptness, there was still a decent amount of sanguinary cleanup required. But my stretchy medical duct tape is in place and all is right in the land.