cannulation advice

[Spunky Tech]

Hey everyone it is so cool to be able to communicate with people who know what your going through. I have been employed at a small clinic approx. 30 pts for a little less than a year. I am a tech @ the clinic and I tell you, I was really blown away with all the duties that go into the position. I had NO experience in nursing and was very overwhelmed. My question is I consider myself a decent cannulator and there are only 3 pts that I tend to have problems with when I try. One pt in particular has a graft that was placed in his leg, the venus site is always easy for me to get, but the arterial I usually have problems with. I have only attempted to stick 4 times, but I have problems with the arterial. It seems to me that once I enter the site with the needle, blood immediately shoots through the tubing and fill the syringe before I have a chance to pull back and return. I am assuming that I am in the right place but when I try advance the needle and pull back I pull air along with blood? The arterial I have been told is slightly deeper and curved so I cant feel for the graft. When I advance am I going straight through the other side, whats the problem? I am losing confidence but the pt always comments about how good the other nurses stick him and how they never have problems. I asked him if he cared if I practiced on him and i told him that it was important for me to learn his access. He said no problem, it didnt hurt. All the nurses I work with are fairly new and the experienced ones dont care to take the time to watch me or work with me to explain what I am doing wrong. Should I just give up on this guy. Please Help!

[soulofme]

I don't care if the nurses are new or not...it IS their responsibility to help you...ask another tech if they won't help...cannulation can be tricky.. I still have problems with some pts... sometimes I just go for it and hope for the best...Had a pt just the other day that my techs could not get.. I tried and finally got him running at a BFR of 250 but he ran...time for his access to get worked on....

[diabo, RN]

I never attach the syringe to the fistula tube until I see a good return. Check and make sure the cap is tight on the tubing before you stick. If you are in the right place you should see a nice pulsing in the tubing. If the pulsing changes or stops when you advance it, stop. Perhaps flipping it will help, but pull it back slightly first as the bevel is like a razor and can quickly damage the graft or fistula. Sometimes the needle can only be inserted 3/4 of the way in. That's fine. Just make sure it is secured well. Loosen the cap slightly to allow the blood to fill the tube, then attach your 3cc syringe with 1 1/2 cc if NS. Pull then push and if it feels good, hook her up.

[dialyzern]

Develop the art of listening. Get a stethoscope before you stick and listen to the sound of the blood flowing through the graft. I listen across the access from left to right to hear the strongest sound of the bruit. You do not have to see it or feel it to be able to cannulate it. Femoral grafts tend to have higher pressures. Grafts can be so deep that the angle of insertion may need to be increased, so you feel the needle's hub is standing straight up coming from the graft. That's ok, as long as you have a good flow. I use a "pillow" 2x2's (folded x 4) to prop the hub so it is more stable before taping across and then butterfly per your unit's policy. Diablo's point of tightening the end cap before you cannulate is invaluable, it is a second nature thing I do now without even realizing.

Sadly, nurses tend to have less cannulation skill and expertise than techs, as they are doing the many catheters and other duties during changeover when you need someone. Sometimes, backing up a hair and reangling the bevel inside the graft by moving the hub that you are holding is the trick. It takes time and practice to develop this skill. Patience is the key. Take a deep breath and don't give up. You're spunky....you can do it!