flipping needles

I would also like this information. One of our patients had slight pain in the area of fistula during dialysis. One tech suggested flipping the arterial needle. I was surprised as the tech asked the patient, "do you want me to flip the needle?". I wondered why the tech did not further explore reasons for the pain or explain the patient about flipping. How can a patient answer a question when they do not understand procedures? I want to know as much as possible in order to educate.

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When you insert the needle bevel up it creates a narrow flap/slit. When you remove that needle it leaves a small opening because the flap/slit edges go back together edge to edge. If you flip the needle, then when you pull the needle out it actually cores out a peice of the graft or fistula. Flipping the needle back before you pull it, or the initial flipping can make the hole larger and cause trauma to the vessel or graft wall. I have to admit that I have had times when the only way to advance the needle was to flip it. I absolutely try to avoid it, but sometimes it comes down to the pt dialyzing or not. The two dialysis companies I have worked for it is against policy to flip the needle.

This particular patient, over a year. But many patients are not educated for many reasons, as well as staff not being able to take time to provide full education. Many patients (older individuals) might not understand fully details. Patients who are asked questions like 'do you want me to flip the needle'? when they do not even understand what flipping the needle means or when it should be done are placed in a situation they should not be in often. As rushed as we are many can not take time to educate.

thanks to everyone for the replies but i still don't know if flipping the venous needle is ok or not... also kat1994, i'm not sure if you meant that you occ. pull needles w/o flipping them back but we were always taught that the needles must go back to the original bevel up position before pulling. nephro bsn,you aren't kidding when you say if it ain't broke don't fix,ESP w/needle placement!! thank you all for taking the time to reply,i'll keep looking for the info too and i'll post if i find any!!

again,thanks for the replies but i think i may have worded the question wrong. i'm looking for information on flipping the venous needles after cannulation! you know how sometimes the arterial needle needs to flipped after treatment has started d/t higher pressures than you would like? so i'm wondering if the same thing applies to venous needles and their positioning after treatment has been initiated. i hope this makes more sense to anyone who can give me info on this question! thanks,terri

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Sometimes the needle, arterial or venous, becomes lodged in the underside of the vessel or in another part, depending on the configuration, and the flow becomes restricted regardless of the backeye. Before flipping it's a good practice to withdaw the needle a little so it won't act like a drill and increase the chance of infiltration. Sometimes you can feel a slight "ping" as you pull on the nededle and you won't have to flip after all. I don't know of any guidelines for venous vs. arterial except do what you must to get the maximum flow.

Steve

One of theirs is ALWAYS USING A TOURNIQUET EVERY TIME ON A FISTULA. I don't "go" along with that theory in the fact that I don't believe it's good to do the same thing to every patient. They and their fistulas are individual and some don't need a tourniquet and again "if it ain't ..... I've seen too many tourniquets left on.. And we know what can happen then.. Venous inflitrate.

NephroBSN I agree. I don't always use a tourniquet either. We have a couple of really big guys who can squeeze their forearms with one hand. They can do a better job of making those fistulas pop out than I can with a tourniquet so I say go for it. Some of these guys have been doing this for years, and most of them are very in tune with their bodies and know what works best for them.

I listen to those long-term patients because they know what they're talking about. I tend to take the lead more often with newbies, but once I see they're getting the hang of their treatment, I defer to their judgement more often. Of course I never ever do anything illegal, unethical or harmful if they request it. If they say "well so-and-so does it," I let them know that it's against policy and I choose not to do anything that is against policy.

we used to flip the needles but since the vascular surgeon told us about the bad effects of it, like creating more damage to the graft, we stopped flipping even for fistulas...here in Miami...pediatric dialysis...

The only thing I can think of about the venous needle is that there could be a clot that formed at the end of the needle. Flipping and manipulation of the needle could cause the clot to break off. I don't have any research to back this up. I have just been told this by the more seasoned nurses that I work with.

Before flipping the venous needle, I would aspirate and see how it feels. Then, depending on how well it aspirated, I would pull the needle back a little and see if repositioning helps.

I don't know.... just my thoughts on the subject