Hey Moo !
This sounds just a tad much for them to expect of you... I've worked dialysis for the past 6 years, and none of our patients use this lidocaine cream. We do have one pt. now whose doc has ordered an anesthetic spray..(and all the other patients snicker at him.. even our little 92 yr. old woman).
If they want you to apply the cream, it is MHO that they should send someone over to you and explain a little bit about the graft or fistula, how they rotate sites and why, and bring along some pamphlets describing the cannulation process... BEFORE they expect you all to comply with their wishes.
Even better, see if they can't use the spray (can't think of the name of it right now, either) but it comes in a brown bottle and is sprayed on immediately before inserting the needle.. it has a "freeze/numbing effect". This would be more suitable and would not neccessitate anyone else's involvement.
That said.. (since you need this for Monday am) ... have WHOEVER will be doing this on Monday am attempt to see where he was last stuck...if it's a fistula, he will have a lower arterial stick and an upper venous stick. If it's a graft, he'll have an arterial USUALLY on the pinky side of the arm, and the venous access on the other side ( if it's a loop graft).. if it's a straight graft it would be arterial lower, venous higher.
This is really asking a lot, IMO, because the pt. is supposed to have his bandaids removed before bedtime on the night of his tx. day. So how are you to find his last stickmarks on Monday am .. unless they mark them or sth. ???
And that certainly is not advisable either. They are expecting you to rotate sites for cannulation sticks which is THEIR responsibility, and really cannot even be determined until the patient is ready to be cannulated... sometimes you have to go somewhere other than you intended with your stick due to all kinds of reasons....and then you'd be applying the cream for no reason if they need to stick higher or lower.. see what I'm saying?
Sorry, Nightowl, but this just does not smell right to me... I don't think it should be your responsibility to take on. If I were you, I'd have someone call the DON of the dialysis facilty ( or if acute/inpt. hospital, then have a dialysis nurse come and assess the sites first and tell you where to apply the cream)... and discuss this with the DON. It just does not make sense to me at all.
Yes, you can feel the "thrill".. a gushing, rushing, pulsating in the arm, and hear the bruit with your scope .. a rushing sound... but that still does not tell you where they want to stick him... in which exact location. Unless you just apply the cream over a large area, which is nonsense.
Hope this has helped a little, but I just don't agree with what they're asking of you... I've never heard of this being done before.