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!

[diabo, RN]

The condition of the access and the patients BP are probably the two most important factors in concerning the use of clamps. Our doc won't allow them. He says they're fine for some patients, but has seen too much damage done as a result of them. These folks that end they're TX with a BP of 100/50, in my opinion, should not have clamps. Assess, assess. If the pulse greatly weakens or stops above the clamp or hand pressure, then too much pressure is being applied. The pressure should be only enough to stop the bleeding and that is all. I've seen some patient's fistulas and grafts damaged by they're own vise-like grip too.

[diabo, RN]

I mentioned the possible damage due to clot formation that can happen to a fistula in someone who is hypotensive. The other side of the coin is those that end the treatment with normal or high BP. We've all seen the large psudoaneurisms on some of the patient's arms. Some of these are caused, at least in part, by applying too much pressure. Over time the fistula just stretches out and weakens due to the high pressure flowing in. Eventually some of them even rupture ending rapid blood loss and the loss of the fistula.

[anurseadvocate]

Clamps are not recommended and can cause fistula damage.