administering medication via fistula needle...

Specialties Urology

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Today, I found out that there is this practice of giving EPO IV via the fistula needle and, by that, I mean injecting the EPO at the actual plastic tubing of the venous fistula needle. I am wondering if there are any hemodialysis nurses here who practice this thing and I am hoping that you can help me accept it. It's just that this practice bothered me and apparently, it's the way things are done at my work.

This practice bothered me...still bothers me. Let's just say I was quite shocked, almost paralyzed, and I feel violated by being made to do it to gain a patient's trust (which I didn't gain anyway for apparently she thought of me as stupid/ "unteachable" after I tried not to do it).

In my nursing experience, never had I seen a nurse purposely puncture a non-self-sealing port. I can see why this practice "isn't a bad thing" but I can also list out reasons why it's not a good idea....

I am asking here on this thread because I cannot just go and have a debate with my seniors and patients. I just recently got hired.

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Perhaps the dialysis nurses are doing it that way?

If the nurses on your floor are doing that, it's a big no no.

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Specializes in Dialysis.

I'm confused. There is an injection port on the venous side of the dialysis circuit for this purpose. But you wouldn't have this unless the patient is connected to the dialysis machine and the dialysis nurse would administer all medications. Please tell me they are not injecting directly into the fistula/graft. :nailbiting: Where, exactly, are your fellow nurses injecting this medication?

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It's the hemodialysis nurses, on my new workplace, who are injecting EPO on the plastic tubing of the fistula needle (not on the port of the venous lines D=). I don't understand. Why can't they just use the self-sealing port?

I used to work in the floors and puncturing tubings/lines just like that really disturbed me. Yes, it's a no-no for us on the floors. I must say, I had the opportunity to rotate in almost all, if not all, areas of nursing and this is my first time to be exposed on such practice. O_O

I want to erase it from my mind but apparently it's the practice of the HD nurses there and it is the practice that those HD patients are familiar with. I don't want to do it but I might have to do it if I want to look good with the patients. And if I have to do it, I'd appreciate some good rationale behind the practice. :p

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I'm also confused - are you a dialysis nurse? If you're not, you should not be doing anything with a patient's access. If you are, are you being asked to insert a needle into the access tubing? You should never puncture tubing anywhere other than an injection port. Normally dialysis tubing comes with injection ports for medications and blood draws.

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I'll admit that I've never actually stuck a needle into a random place in the dialysis tubing, but I certainly assume it would leak. I mean if you make a hole in a spot where there shouldn't be a hole then it's going to leak.....so how could they possibly be doing this without creating an enormous mess????

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Specializes in Med/Surg, Tele, Dialysis, Hospice.

I've never heard of anyone piercing the tubing to give a patient's treatment meds. Why on earth would they need to do that when there are so many other ports in the system that are designed just for administering meds? We give all of our Epo and Hectorol through the port in the saline line that is designed for that. It's quick, easy, and most importantly, self-sealing. If you pierce the tubing, don't you get blood leaking from the puncture sight? Not only is this a break in an otherwise sterile system, but it seems that it would be distressing for the patient to deal with.

I'm not the most assertive person, but I would certainly question this practice to my clinical manager, and ask why they don't use the self-sealing ports that are designed for giving meds. If it ticks him/her off, who cares? It's more important than compromising your nursing practice and putting patients at risk.

Oh, and if a patient seems to think of you as stupid or unteachable for questioning this practice, you can always explain them what the self-sealing ports are for and why that is the normal place to inject medications. No way should you be the one who ends up seeming stupid for wanting to do things the proper and safe way.

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Specializes in Nephrology, Cardiology, ER, ICU.

Are you in the US? What type of place todo you work at? A dialysis unit? Or hospital floor?

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I want to erase it from my mind but apparently it's the practice of the HD nurses there and it is the practice that those HD patients are familiar with. I don't want to do it but I might have to do it if I want to look good with the patients. And if I have to do it, I'd appreciate some good rationale behind the practice. :p

I think I would rather be safe than look good with the patients. There is no good rationale for piercing tubing - it breaks sterility and invites leaking, as well as raising the potential for needle stick injury. Why on earth do your coworkers not use the injection port?
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Specializes in Dialysis.

Do you mean administering it directly into the tubing of the needle? Not actually PUNCTURING the tubing right? In any case, I haven't heard of this practice yet. I know that we're suppose to administer the heparin through the needle tubing if they get it, or the venous chamber of the lines.

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Are you in the US? What type of place todo you work at? A dialysis unit? Or hospital floor?

Presently, I am working at a hemodialyis unit (out-patient). It's outside the US but the company has these plenty of protocols adhering to US practice. This is actually one of the reasons why I got shocked with the puncturing. I never expected it from such an organized, and innovative unit. I have trained in a somewhat filthy and chaotic (my exaggeration) hemodialysis clinic but never had I seen anyone do such practice until this present.

Thanks for the responses everyone. It helped me. I've decided to stay quiet for a while because I can't afford to be the "know-it-all" new nurse. I think I'll "innocently" ask the head nurse about it sometime in the near future. As for the patients, I have decided to be very fast with my hands so that I've already given the EPO before they can react to my "unusual practice". Act first, explain later. >=DDD

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