Bevel up, Bevel down???

[ESRD]

Hi,

I have been in hemodialysis since 1987.

I recently ( two-three years ago actually) was taught to put my fistula needles in bevel DOWN.

Anyone else doing it this way?

ESRD.

[kampartist]

The rational of bevel up bevel down has been discussed for many years. Generally in a fistular bevel up works best however in a graft depending on the access level and location sometimes bevel down is indicated, Generally I find bevel up to be best as less trauma especially venous.

[ESRD]

I go bevel down all the time.. I don't flip my needles .. No need to with bevel down. Bevel down actually makes a nice flap for speedier bleeding times. I also have noticed that patients state that the needle stick doesn't hurt nearly as much..

As an aside going in bevel down prevents trauma to the rear wall of the access if you need to flip needle

Just my two cents..

ESRD

[live4today, RN]

About 8 or 9 years ago, I remember attending an inservice on starting IVs with the needle "bevel down". It was reported that by going in bevel down it caused less trauma to the vein. Interesting to see this being talked about here after all these years as I haven't heard talk about it since that time.

[ESRD]

I'm actually talking about cannulating a dialysis access; either a fistula or a graft with a 15 or 16 gauge fistula needle not an ordinary IV stick.. I always go bevel up there..

Rarely, we will also use a 17 gauge fistula needle in a small fistula.

With the pressures internally in a dialysis graft one tends to get the needle up against the wall resulting in negative arterial pressures.. Bevel down can fix that problem in many instances. When I go in bevel down I don't need to "flip" my needle thus NOT scraping the back wall of the access..Also, bevel down makes a nice flap. Makes for quicker bleeding times at the end of treatment..

ESRD

I don't even want to mention the use of Tums directly on the puncture sites...

[MaryMc/RN/CM]

In regard to bevel up, or bevel down...I was taught that you use bevel up for venous access and bevel down for arterial access...the rational as I recall had to do with the direction of blood flow and how it effects the flap created by the catheter bevel. The goal being to use the direction of blood flow to close the flap and reseal the vessel.

[550Qb]

TUMS on sites? explain this please :)

[Chisca, RN]

Has to be the calcium.

http:allnurses.com/dialysis-renal-urology/calcium-carbonate-powder-326303.html

[wordsmith]

Funny how things vary. We always do bevel up, are not supposed to flip needles, but occasionally have to depending on the patient's access. We do use lidocaine by request on accesses; I understand that many clinics don't.

I never heard of Tums on an access.

[Chisca, RN]

I never flip a needle. I "reposition" the needle.