I am new to dialysis. In the training films I watched for orientation, nurses and techs were shown cannulating bevel-up, then rotating the needle in the graft so that it would face bevel-down for the tx. Also, bevel-down cannulations were shown. The film stated that bevel-down is the preferred method for cannulation.
Everyone just does it bevel-up and leaves it that way where I work.
Do you cannulate bevel-up or bevel down?
Is bevel-down really better?
And Life-Sites...ugh. They are such a PIA. It is so hard to find the hole, and they run poorly. None of our pts with Life-Sites can run at a BFR any faster than 250.
A company rep gave an inservice today where I work. She says that BFR on Life-Sites should be 500!
None of out Life-Site pts can run at that rate.
What about yours?
Mar 12, '03
We never do bevel down. I'll ask tomorrow about why and get back with you. I do know that occas'y if there is a problem we have tried the bevel down, but very rarely. And what is the "Life Site" you are mentioning? Don't know if we have those, or if it's a different terminology..?
Mar 12, '03
Here is a link that explains the LifeSite.
Personally, I don't like them. They take up a lot of time. Also, you have to stay in a bent-over position for a long time to work on them and it really makes my back hurt.
When bevel-down has been used at your unit when there was a problem, did it help?
Mar 12, '03
I believe that flipping the needle after insertion used to be standard procedure, but I was taught that they stopped doing it because some study said that rotating the needles could core out segments of pts grafts over time and that you might nick a fistula with the bevel and end up with a hematoma. I have found it useful to flip the arterial needle if afterial flow is poor. Thank god our docs never used the Life Site, they said that they weren't worth crap!
Mar 13, '03
Checked on that today... yes.. Telepathic is right.. used to be that bevel down was standard procedure. We never use it. (HARDLY ever)
Supposedly, when the bevel is down, you're getting better cleaning of the blood, as there is less recirculation that way. However, it just doesn't do very well that way...at all. We have flipped the arterial occasionally, too.. it has the back eye, so it works pretty well.
We don't use life-sites.. at ALL. Our doc doesn't believe in them. Period. So that clarifies that. Thanx for the link !
So how's it going for you? Feeling your way around? Getting any support there? Stand up for yourself ! Let them know what your needs are !
Mar 17, '03
When I started in Dialysis in '94 we flipped the needle after inserting bevel up to help prevent sucking against the wall of the vessel and to creat a "flap" that supposedly stopped bleeding faster. With the backeye needles it ended the problem with flow rates and we found out about coring the graft so we now only flip needles if we have to. We also found that you can fold the butterfly over and that also helps.
Lifesites are only as good as the surgeon who puts them in. Once the button hole is there it is easier to get the needles in. If you have trouble with your catheters you will have trouble with your Lifesites. We have an excellent surgeon who puts ours in and we get a 400 BFR from day one. He also lets us cannulate it the first time to assist with getting the buttonhole correct. They are a good alternative to catheters for letting a fistula develop.
Mar 19, '03
Our local surgeon wants all grafts cannulated bevel down he says that it causes less trauma to the graft some pt.'s say it hurts less as well i usually cannulate the arterial down on both grafts and fists and then venous up on fists it was the way i was taught and seems to work for me
On the subject of life sites has anyone shared the FDA investigations from last summer with you..................... i do not like them they take to much time and half the time the flow is not what it is to bee the reps for the company i have dealt with 3 of them and each one told our clinic staff another way than the other although the one could recite the instructions per the co. like the bible
the bearings that are to hold the needle in place let loose twice in the first 30 days with our first one the co. answer was that it was "operator error"I tell you now i am anal about my accesses the needle was seatedluckily the pt. was fine but any way sorry to ramble anyone looking for the true info on this thing needs to find the FDA investigations on it from last summer
Mar 23, '03
I got copies of the FDA investigation of the LifeSite device and gave it to my boss.
We have 4 pts w/ LifeSites, and none of them work as promised.
We only get 250-300 BFR on one the other two run at 250 max.
We made new holes on two of our pts, which helped w/ needle insertion, but they are still really difficult, and time consuming.
When I get a good candidate, I'm going to try bevel down cannulation. The techs are going to think I don't know what I'm doing, but I want to give it a try if it can work well!
We used to give our pts a heparin bolus of about 2000u at the start of tx, then 1000 hourly during tx. The company has changed the policy so that we now give a larger dose at the beginning of tx (5000-6000u) and no hourly.
It seems to be causing the dialyzers to clot off and kecn numbers keep getting lower. More alarms and flushing dialyzers w/ saline, which of course, means the pts get more saline.
Are any of you having these issues w/ heparinization?
Mar 23, '03
I work acutes now, but when I worked chronics, we had to do a qtrly "heparin dosing assessment". That is where you pick a day and decide to give the pts their regular bolus dose and flush the dialyzer with 100cc NS Q 30 min and record what the dialyzer looks like, and also if there is any sign of clot formation in the venous chamber. This worked well, because you could then increase the bolus based on the protocol.
In acutes, we just started a "tight" and a "no heparin" policy. Tight is where we admin 15-20u/kg of EDW as a bolus and then we flush the dialyzer Q1 hr, it also has a provision that if s/s of clotting are noticed, then you give the pt another heparin bolus at that time of something like 20-30 u/kg. All NS if figured in the goal on both policies. Have seen this help, just more work for us!!!
Apr 20, '03
Where can I find this FDA investigation of the LifeSite?
HATE 'em. Can't get a Qb of over 250 (measuring pre-pump arterial pressures), almost always have to activase them, patient's URR never over 58, uh-uh. Gotta go.
Apr 20, '03
We don't do Lifesites at ALL. Our docs won't have them.. say they are nothing but infection magnets.
Most of our caths don't run over 250-300 BFR, regardless. That's expected. We do flush those who are prone to clot, but we always figure their flushes into the goal at the start of tx.
We titrate our heparin boluses and pump amount according to each individual... their weight, etc. We keep it that way until things change with the individual.. if they start losing/gaining a lot of tissue weight, ie. or if they're prescribed coumadin, etc. So it varies. We don't have an "across the board" initial bolus amount. Some of our pts. are on a hep. pump and some aren't. All get the initial bolus, but the amount varies from pt. to pt.
Apr 22, '03
We do not use the pumps anymore. We give a heparin bolus at the beginning of the TX and that's it.
The big-wigs of the company decided it.
I think there are a lot more problems with clotting, now.
To find the article on FDA investigation of LifeSite, just type in Life Site dialysis into google. That's how I found it.
Apr 22, '03
Hellllllo... we work for the same company.. it just boggles my mind how there can be so many variences ! Why is it that we use heparin pumps and you guys don't get to? I don't understand this. If it were a different company, I could swallow that. And we aren't even doing reuse anymore.. even less reason to use the pumps ! )..except, of course not wanting the pt. to clot off during tx.)
Are they hounding you all to use the saline SPARINGLY? (and by that I mean not for the PATIENT'S sake, but for the pennypinchng).. just curious.
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