[jmtmom]

Hi Jnette!

That ethyl chloride spray sounds wonderful! So I did some searching on the internet for information about the spray. Figured I could print it off and pass it along to the head nurse as something we could possible implement at our clinic. Well my search yielded some interesting results.

Ethyl chloride is a refrigerant that is used for variety of things, one of which is a local anesthetic. It works by literally freezing the skin. But it must be applied carefully, as it could actually frost the skin, killing tissue. Surrounding tissue must be protected with patroleoum jelly. Inhalation of this substance could cause some problems, and it also flammable. It is also listed as a hazardous material.

However, it obviously is used in the medical setting. I wounder, though, if it would be apropriate for routine usage in a dialysis clinic, given the fact the the majority of cannulations are done by non-licensed personnel. But is is less expensive than Emla cream. This stuff is about $27.00 per bottle.

Here's the site where I got the info:
http://www.chaseunion.com/documents/PDS/ethylch1.html

[TELEpathicRN]

Good suggestion Jackib!!! Keeping a diagram of the pts access and where they would like the cream applied for the next treatment would help the very busy nursing home staff!! If the pt gets to the dialysis clinic and the nurses aren't able to stick the pt in the areas the EMLA cream has been applied (many reasons why), they could just offer the pt SQ lidocaine for that treatment.

[Northern nephron]

Hi, wanted to know what the final outcome was...I am reading this long after the original posting. I am a hemo nurse and the emla is a lifesaver for the patient. We can always use a local lidocaine needle but the rationale is why poke twice - poor patient. The patients in most hemo units are considered outpatients and therefore it is their responsibility to apply the cream if they want to use it. It does come in handy patch form with a peel and stick backing that covers a large area allowing the hemo nurse to then have options on where to place the needles. Ask the patient where it should be placed - they should be able to tell you where the last needles were. Also, in defense of the poor hemo unit - if the patient comes and requires the staff to apply the topical freezing and then wait for an hour for it to take effect - they may not get a full dialysis treatment because this will take one hour out of an already full treatment block of time. By this I mean that most units run 3 shifts/day so patients have a block of time (8-1230 for example) and if they need 4 - 41/2 hours for a full treatment there is not enough time for them to wait for the cream to work. The cream is really simple and effective and is a patient saver....

[cruss]

Night owl,
I read all of the postings concerning the Elma Cream and there is something that everyone seems to be leaving out. The patient! The reason for the Elma Cream could be that the patient has allergies or a sensitivity lidocaine, fear of needles or many other reasons. I am a registered nurse and have worked in Dialysis for 20 years and I can assure you that saving time is not the reason they are asking you to do this. It takes less than one minute to inject lidocaine in both sites. We have one patient that uses it because his fistula is so close to the surface it is difficult to inject the lidocaine without penitrating the fistula. He could do without any thing but he is afraid of needles.
The reason for rotating the sites is so that they do not wear the fistula out by sticking the fistula in the same spot all the time. It would be good for you to move the sites of application up or down about 1 inch each time, and if you would use Saran Wrap to wrap around the arm it would work better than the tega derm. They ask you to do this instead of doing it themselves is that it takes about an hour before the cream is effective. I would suggest that if you have time, stop by the dialysis unit sometime and discuss this with the nurse and you would have better understanding of what is happening to your patient when they go there, and I bet they would be happy to inservice you on the dialysis access. If you would like more information on the dialysis patient the National Kidney Foundation has a great web site @ www.kidney.org.
I hope this clears up any confusion that you have.
Experienced

[GeauxNursing]

Our people apply the cream, rub it in, rub it in, rub it in, cover in cling wrap about an hour before, then come to dialysis. (probably not the correct way to do it, but that's how it's done.) we had one lady who it just wouldn't work for. she tried all different ways of apllications, varying the times and amounts she used, still had really painful sticks. we could never figure it out.
Oh! The people who use it just smear it all along they area that they know could possibly be cannulated. none of this "2 spots" nonsense. lol. they want to be sure they are covered.
we have one who uses the spray, she still screams.
some ppl just get lidocaine injections.

[annfaith]

I currently work in a dialysis unit and we have two patient's who use the Emla cream. They are responsible for putting it on themselves. When they arrive to the unit, and prior to cannulation we remove the saran wrap or whatever they have choosen to cover the site and wipe the cream off and clean the site with betadine ( yes we still use betadine) prior to inserting our needles. This is the practice that we have used. Any in-patient's have the option of lidocaine (another shot) prior to treatment. Most patient's just go cold turkey and resume whatever practice they had prior to admission. Keep in mind I am a dialysis nurse. It is our responsibility to take care of these issues. Maybe management or the doc needs to be made aware of this.

[mmurphy]

This "pulse" is called a thrill. It is basic nursing 101. A patent graft or fistula will have a strong "thrill" when palpated. The thrill is from the anastomosed artery and vein, if you do not feel this thrill likely the graft/fistula is clotted. When ausculatated the graft or fistula has a stong swoosh sound known as the bruit.

Secondly Emla cream is widely used. 90 year old patients apply it themselves a hour before dialysis, it is not a huge deal. It should be applied over the entire access, as you do not know where the dialysis staff is going to cannulate the access. Apply liberally and cover with any type of dressing or simple saran wrap.