[PLTSGT]

I just don't see the rationale why some facilities forbid the use of clamps. The pressure some patients put on their sites is harder than what clamps provide.

Any input?

[iriskkerry]

Hi PLTSGT. Generaly most of us use them for pts who for one reason or the other cannot hold their sites post tx, like paraplegics, those with handscramps, etc.

[traumaRUs]

Personally, I think the pressure that the clamps exert IS more than one uses when using your hands because with a clamp you are exerting pressure on both sides of the arm.

[diabo]

Fistulas and grafts can be damaged by having too much pressure applied either by clamps or by too tight a squeeze. In most cases clotting is cumulative, and will finish forming with a good bout of hypotension, ending up in a medical emergency. Pressure should only be applied hard enough to stop the bleeding and should never occlude the access. As the clot begins to form, the pressure should be lightened, allowing the clot to form faster and fuller.

[jnette]

Originally Posted by diabo

Fistulas and grafts can be damaged by having too much pressure applied either by clamps or by too tight a squeeze. In most cases clotting is cumulative, and will finish forming with a good bout of hypotension, ending up in a medical emergency. Pressure should only be applied hard enough to stop the bleeding and should never occlude the access. As the clot begins to form, the pressure should be lightened, allowing the clot to form faster and fuller.

Agree. Clamps can really wreak havoc... why chance jeopardizing a lifeline. Clamps should be used only when no other reasonable alternative is available.

[PLTSGT]

Thanks for everyone's input!

[Rocknurse]

We use clamps as standard here in Acutes. Every patient gets clamps. Our patients are in the ICU most of the time so they are not able to put pressure on their own fistuals/grafts.

[DeLana_RN]

I work in a hospital inpatient/acute unit. Our standard of care is for pressure to be applied by the nurse or patient, with clamps as needed. I only use clamps if I have to (and usually no more than one at a time) and try not to use them with fistulas at all.

With alert patients, I make sure to teach that they should avoid clamps if possible - however, I realize (having been there) that in chronic units this is only possible if patients are willing and/or able to apply pressure themselves. I do know, however, that many patients are never given the option to hold their sites (staff routinely use clamps, patients may not know better), therefore the need for teaching.

DeLana

[Lacie]

I currently work in a chronic unit and they routinely use 2 clamps even on pts who are entirely capable of holding thier own sites. On a personal opinion I dont like them at all! Most of the time pt's tell me they just "dont like to" and the staff "dont have time to hold for them". Out of 14 chairs on our first shift (we have 3) I have only 3 pt's that actually will hold thier own sites. I see too many times where clamps are placed improperly or are not monitored resulting in unnecessary blood loss and not noticed until a very visible puddle is usually seen on the floor. Not to mention the other issues they can cause with grafts/fistulas. (I already gave my 2 weeks so hopefully moving to acutes wont be the same.)

[DeLana_RN]

Originally Posted by Lacie

I see too many times where clamps are placed improperly or are not monitored resulting in unnecessary blood loss and not noticed until a very visible puddle is usually seen on the floor. Not to mention the other issues they can cause with grafts/fistulas. (I already gave my 2 weeks so hopefully moving to acutes wont be the same.)

Worry not, acutes is nothing like chronics. We actually have the time to hold the sites (or encourage capable pts to do so) and if we do use clamps (I may use one clamp if I have a graft with prolonged bleeding) we can certainly monitor them closely (our ratio is 1:1 in ICU or ER, 1:1 or 1:2 in our unit).

My unit is staffed by nurses only; very different from chronics, and very nice. I think you'll like acutes!

DeLana