Clamping Needles Sites

[Robbilin]

Tell me, what do you all think of using clamps on graft and fistula needle sites? What is your technique - like use one clamp and hold the other needle site, no clamps ever, use them all the times?? And if you do use clamps, what is your policy for cleaning them? We do use them, and they all get wiped down and then thrown all together in a basket. They are labeled for each patient, but the cleanliness is only as good as the person who wiped them down. I only know what our facility does and would like to hear what other places do. Thanks!

[Hellllllo Nurse, BSN, RN]

At my facility, a pt must be able to hold both sites at once, or a staff member holds them in order to have both needles pulled at the same time. A pt can have one site clamped, but can't have both clamped at the same time. For example: one site is clamped and the needle is left in the other site. When the first site stops bleeding and is taped up, the needle is pulled from the second site and is clamped.

We do not label clamps with pt names. When a clamp has been used, it is dropped in a bucket of bleach. They sit in the bleach all day until clean-up at the end of the day. Then, they are rinsed off. No need for wiping when they've been soaking for a long time.

We put them in a vented plastic basket to rinse them, then they drip dry in the basket.

We do the same with the "blue clamps" or plastic hemostats.

[Diva]

My facility uses the same procedure as that of Hellllllo Nurse.

The bucket is half filled with a bleach/water solution (I believe it is a 3% solution) each morning. It is also labeled with the contents of the solution, dated, and the time of mixing is also on the label as well as the name and signature of the person who prepared the solution.

The solution must be discarded and new bleach solution mixed q 24 hours. (Ours is discarded at the end of the day just as Hellllllo Nurse states.) The label shows that the solution is within the time limit. State inspectors are impressed when they check the label

[GTS]

The clinics I service are DEPENDANT on the clamps. Everyone uses them. I think they're somewhat dangerous myself, but they seem to work well for the most part. :)

[jnette, ASN, EMT-I]

We use clamps on fistulas if the patient is not able to hold their sites, and only very occasionally on grafts. (they can damage a graft if used often).

Many patients are not able to hold a site..ie, if they have Parkinsons, or are feeble and "shakey". When we DO use them, we clamp either both sites or just one and hold one.... whatever the need is.

If a patient can hold their sites, we let them decide if they want to hold one at a time or both... either way is fine with us. Some are more comfortable with holding one at a time.

We throw the clamps in a 1:100 bleach solution bucket along with the wands, etc.. The hemostat clamps we spray with bleach solution, rinse, then wipe and rehang.

[Robbilin]

Thanks for all these ideas and suggestions. We are kind of dependent on the clamps too. As far as the bleach soaking, does anyone know how long they have to sit in it? (For the state to be happy!) Robbilin

[jnette, ASN, EMT-I]

Originally posted by Robbilin

Thanks for all these ideas and suggestions. We are kind of dependent on the clamps too. As far as the bleach soaking, does anyone know how long they have to sit in it? (For the state to be happy!) Robbilin

As far as I know, and I certainly may be wrong here (just going by our own protocol) 30 minutes is sufficient. Bleach solution works pretty quickly from what I've been told.

[nursefiggy]

I was trained to use clamps only on grafts, never on fistulas. ???

[jnette, ASN, EMT-I]

Originally posted by nursefiggy

I was trained to use clamps only on grafts, never on fistulas. ???

Interesting. We were taught the exact opposite.

[nursefiggy]

Well, they say dialysis protocols are always changing...... I guess it depends on who trained you. I was trained about 20 months ago.

[mittels]

1:100 bleach solution and let them soak

[mmurphy]

I was trained to use clamps only on grafts, never on fistulas. ???

I think that this clamp issues cnme from the "fistula first " program. The suggestion was to no use clamps on newly underdeveloped fistula for fear of clotting. Comparing a developed fistula with a graft the obvious risk for clotting using clamps would be the graft. This is a great deal of lack of education among dialysis managers (particularly in hospital run dialysis clinics), and unfortunately there is often no rationale behind many of the rules in these clinics. A grest example NOT USING SITE CLAMPS ON FISTUALS COME ON!! If the clamps are used correctly the will not risk clotting an access.