[sueinga]

Hi,

Everyone pretty much agrees that when accessing a new fistula to use 17g x 2 weeks then 16g x 2 weeks and ultimately 15g unless otherwise ordered..........but I've heard conflicting views on what size needle to use when accessing a new graft, what is your rule of thumb regarding needle size and also pump speed with a new access?
Thanks anyone

Sue in GA

[MSLNT1.1]

With a graft there tends to more give room because it is not the use of the patients native artery and vein. Yoru best bet it to get the order from the nephrologist. And sometimes to them that may seem tedious, but just imagine having a BFR that is to high and the access infiltrates. In many clinics that I have been in the BFR is usually between 400-500 as long as the arterial pressure does not exceed an -250. Aim low maybe 400 and if the patients labs shows that the URR/BUN is good then there may not be a need to increase, but if URR and bun are high then a higher BFR may allow for more waste to be cleared per/minute resulting in a more sufficient treatment. I hope this helps.

Originally Posted by sueinga

Hi,

Everyone pretty much agrees that when accessing a new fistula to use 17g x 2 weeks then 16g x 2 weeks and ultimately 15g unless otherwise ordered..........but I've heard conflicting views on what size needle to use when accessing a new graft, what is your rule of thumb regarding needle size and also pump speed with a new access?
Thanks anyone

Sue in GA

[Pamilina]

There is a form that specifies what size to use for how long, and each size has an allowable blood pump speed. You can't just put a pump speed up to 400 or 500. You have to remember what gauge needle allows for what speed. 17 gauge I believe is 200-250...but double check in the Policy and procedure handbook.

[MSLNT1.1]

My intention was not to say just clearly turn up the BFR between 400-500 that why I stated it is best to get the order from the nephrologist. Also not every clinic or region uses tables and guidelines. My reference to the BFR of 400-500 was in reference to a AVG and not a AVF which takes a lot longer to mature. Yes typically with a 15G needle and depending on length of needle will determine wheter you can achive a higher BFR. But please do not make assumptions before getting an understanding of what I stated and it I took your statment out of context then for that I do apologize. But to the orginial member who posted the thread find out if in your particular clinic or region that you work if they do have established guidelines or policies regarding BFR for AVF/AVG.

[Pamilina]

Thanks for the clarification.

[DeLana_RN]

Unlike a new AVF, a new AVG does not require smaller needles sizes or slower blood flows, although it cannot hurt. And although a graft does not have to mature, of course, at least 3 weeks should pass before the first cannulation (to help it get "anchored" in the tissue).

So if there are conflicting opinions in your clinic, they may all be right I would recommend checking your company's P&P, which should specify the initial cannulation of both AVFs and AVGs.

DeLana