cannulation

rnbob · Dec 31, 2010

Most critical is to compress the skin for patient comfort- can't emphasize this enough-it's scary at first, I was afraid it would make it harder to hit the vein- but it doesn't, once you are inside, if you can't get a flash just keep trying, there is very little discomfort to the pt. in probing compared to breaking through the skin. Of course I am assuming you are following all the regular advise about going in on 45or 90 degree angle and then flattening to the skin once in the vein. Use a tourniquet on all fistulas, but never on a graft.

Good Luck- you'll be great, I know because you care enough to ask. I'm sure you'll get plenty more good tips, but if you want more just ask!

GeauxNursing · Jan 1, 2011

Wow ok not 45-90 degrees! More like 15-30. And probing does hurt our clients if you end up infiltrating. What I do for difficult sticks is feel with my 2 fingers all along the area I plan to stick, palpating for a good track that the needles will follow. Once I ID my sites, I clean. Then I put my 2 fingers above the area I will be sticking, to palpate and guide myself in the right direction. The light stretching of the skin is also important. You rest the pinky of your needle-holding hand onto the skin below the site to hold skin taught, while using your other hand, 2 fingers, to pull the opposite way, gently, above the site as I previously said.

It takes time to get really good.

Digging also gets you into bad situations when a clot develops in the tip of the needle, making you think you;re not in the vessel when really you are. If there is a clot in the tip, chances are you won't get a flashback.

gambutrol · Jan 1, 2011

thanks guys!

sunfirebsn · Jan 3, 2011

The most important thing is to take the time to assess the fistula/graft carefully with your fingers and stethoscope before you put the needle in. It pays to take a few extra minutes doing this instead of spending 20 minutes fixing a bad needle or having to stick the patient 3 times. Pick your spot and make sure there is enough space to advance the needle in (usually 1 inch needles). You will get better with experience, but always remember that everyone, even if they have been doing it for 20 years has difficult cannulations at times!

Dialysis RN1 · Jan 15, 2011

oooo, 15 degree canulation??? It is more typical to do the 45 -90 degree as rnbob mentioned. a 15-30 degree canulation is more designed for an IV insertions. usually fistulas and grafts are just a bit deeper and a clean introduction of a large bore needle will give longjevity to the access. canulating at 15 degrees can sheer and also not alow you to get fully into the access.