cannulation

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!

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.

thanks guys!

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!

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.