frustrated

iluvivt, BSN, RN · Oct 31, 2008

If you love it ,I say hang in there. But in order to get better at cannulation you will need to do a few things. You need to observe the techs and RNs that are great at it and ask lots of questions. Every single time you miss try to figure out what you need to do differently next time. If you have a patient that is difficult for you...ask another that has great skills to show you how to get it or have them talk you through it. Also try not to be too hard on yourself..it is obvious you care about the quality of care you are able to deliver or you would not be this concerned. Give yourself some more time...but to it with a plan for improvement.

lunden · Oct 31, 2008

hi there, i've been a dialysis tech for 14 years and i can tell u, u will always have good and bad days. i consider myself a very good sticker, but i swear yesterday this one fistula i'm always pulling out clots and having 2 stick him again. i called the nurse over and i recanulated him again, had a good flash, got him running and arterial starts bottoming out. meanwhile (cause u know this always happens during turnover) i had 2 get the nurse again because it was going on 12 and i had 2 get my last pt on. but the point is i have more good than bad days, usually when i can't get a stick it's becuz there's a clot n the needle and i have to restick. i make sure 2 show the nurse and pt the clots and i record it n the computer. u won't get every stick, and i have found that the "perfect" tech's where i work, when they do have to restick they do it in such a "sneaky" way (i know, becuz when i have that pt, there like,"so and so had 2 stick me twice) or they are sticking pt's so close together that they aren't getting a good circulation. or they r sticking n the same spot. so just do what u can and get help when u need it becuz nobody is perfect. sorry this was so long, but i never reall come across any dialysis tech's on this forum. by the way r u looking 2 become a RN? r u a certified tech?

Spunky Tech · Oct 31, 2008

Hi everyone, and thank you for the good advice you are so right on. I should definetly observe what it is that I am doing differently during these cannulations and I should also watch the ones who I feel are really good at it. The thing about it is, i get nervous during cannulations and although I plan it all through before I cannulate, once I punch through the skin, its like a fog comes over my mind and I have a hard time remembring every detail of how I positioned the needle or depth or angle. i find that particular difficult when I stick pts. who I havent cannulated in a long time. I am also embarassed to ask to stand in with a tech or nurse bc i have been there a year and I feel like i am in orientation all over again. We have a nurse and 1 tech there who I absolutely hate to ask for help bc they are so arrogant. When others ask them for help they sense that as power and they will immediately take over every aspect of the duties, and I'm not the only one there who feels that way. When I ask them for help, i am only feeding into their arrogancy. And the tech who is so arrogant has only been there a year, miss know it all, she runs around trying to tell people about certain aspect of dialysis when i know her information is wrong bc I either look it up or check with the director, but she'll fight you to death that shes always right. She evens bucks our senior tech who has been there for such a long time she is so knowlegeable. If the senior tech is working I have no problem asking her for help bc shes sweet and dosent make you feel stupid. Thanks for letting me vent bc I've had that on my mind for a long time.

lunden · Oct 31, 2008

practice makes perfect. the arrogant techs that we did have, no longer work with us. i am one of the best stickers, but like i said when i get asked to reposition a stick i just go do it w/o all the "talking", because i know it's frustrating for anybody to have to ask for help. as for the arrogant tech just try and ignore her, i know it's hard. i concentrate and i do not rush when sticking, i believe that is why i do have successful sticks. who do u work 4? i work 4 davita and i am currently waiting for acceptance papers for spring 09. while taking prereq. i became certified back in april. even though i am certified and went to preceptor school my charge nurse and FA still pass me over when we get new tech's for another who only has 5 years exp. vs my 14 (we deal with FA's having favorites) and constanly go to the other tech who is not certified for all kinds of suggestions, but i try not to sweat it although it still bothers me. i'm so addicted to this site that on down time i log in at work to "get away from work".

Spunky Tech · Oct 31, 2008

Lunden, you are such an awesome person. thanks so much for giving me advice, i work for a hospital my clinic is privately owned. i do plan on taking preriquesites in Jan. so that I can apply for the RN program at a later time. It's cool to have someone like you who has been doing it for such a long time to talk to about this. I am not usually negative person, and I do love my job I get along great with the pts. Sometimes, I feel like everyone at this site probably thinks I'm a nut bc of the ranting posts I made about the cannulation problems. i just know that if I could get better at my sticks than those arrogant know it alls would have nothing to use to make me feel bad, because I would then feel confident that I do do a good job. Im not out to make others feel like they are inferior I just want some confidence to claim as my own. the thing is I picked up on the other aspects of dialysis with no prob, cant figure out the prob with the cannulations though? Thanks so much Lunden, and please feel free to write me any time bc I enjoy talkin to u!

lunden · Oct 31, 2008

will def. keep n touch and i do appreciate what you posted. i'm sitting here watching "Michael Myers" movies and enjoying my day off b 4 i take my kids trick or treating later on. (5 and 9 years old)

anurseadvocate · Nov 3, 2008

Perhaps speaking with your facility educator/inservice educator would help. ALso, often speaking with patients as they are the ones getting stuck and can often provide much information. Speak with your coworkers and ask them about those you can not cannulate and how they cannulate these individuals. RenalRuth :nurse:

lunden · Nov 4, 2008

hey, thought about u today at work. had a fistula that kept the machine alarming like crazy. it ran good when i first put him on, then all i could get was 450, flipped the needle over and got 520, ran good for a while, but would keep going off. the final end result was him running at 400. luckily we get along good or that would have made it worst. then when i finally get him situated the lady next to him started going off, like they were tag teaming. it was pretty much time 4 her to come off. she has a ugly fistula, hard to stick and i think sge may have infiltrated the needle some kind of way by fidgeting becuz it was time 4 her 2 come off. hopefully i'll b n another section wed. or i told my friend to come over and stick her if i have her.

Spunky Tech · Nov 4, 2008

Hey everyone. Thanks anurseadvocate for the input. the jiff is almost everyone at the facility is quite new to dialysis. There are only 2 individuals who have been there over 2 yrs. One is a charge nurse, the other a tech, which the tech is great at answering ?s. The charge nurse gets irritated when u bother her with probs. Technically we do not even have a inservice educator, there is 1 tech who trains everyone and shes gets tired of doing it, can't say that I blame her. I ask the pts for whom I have trouble cannulating about their accesses before we start, and most of them don't even have a clue which site were pulling and which site were pushing from, those people are the older pts so its understandable, but it makes it hard on me when the pt has no clue about their access. Lunden, do u think it would be embarassing if I ask the senior tech if I can sit in with her on some of the hard pts for me? Most of the time, when i ask for help with a cannulation and the nurse is able to access it for me they can never explain to me how on earth the technique or position depth angle that they used to access. So I never know what it is im doing wrong bc they cant tell me what it is they are doing right? Lunden, how long did it take you to get good at cannulating. I was super excited when I seen that u had wrote a post to me. I so hope ur day goes better wed. Did u have a good halloween with ur kids? I did, my little girl was a unicorn, shes so cute. I tell u lunden there are a many days when i hate even going to work bc I fear that i am going to be stuck with one of those pts i cant cannulate. We have no pts assignments, its free for all. So if everyone grabs all the pts i can do, im stuck with the hard ones. will it ever get better. I talk to u later Lunden take care and I love to chat with ya.

lunden · Nov 4, 2008

some pt's know their arterial side and some don't. we push down on the anastamosis after the needles are in and whichever blood is pumping harder is usually the arterial. years ago i was taught the inside was always the arterial on a horseshoe and the bottom is always the arterial on a straight graft. asking the senior to watch what she does would not be embarassing at all. most of the time when i have 2 help someone with their stick, it's usually becuz they r not deep enough or the r off 2 the side and i let them know. it took a while to finally get comfortable with sticking. it was some years back, but when i started off i was scared as heck 2 stick anybody. i worked today but just til 10 (kids didn't have school, wanted 2 go vote) and the morning went good. had a good halloween 2, we go out 2 ferndale where they really go all out. i bet you're daughter was a little cutie, mine was a witch and a skeleton. u will eventually get better and better, but i even have a couple of pt's that i hate 2 c coming, but i just take my time, and when i can't get it, it usually isn't a problem, hopefully it will stop being a problem 4 u 2. i haven't worked n a clinic n a long time where there was no pt assignment and it was a free 4 all. def. wouldn't work where i work at. we have a 4 2 1 ratio and sometimes 5 depending on the call in's. talk with u later

workingmomRN · Nov 7, 2008

I have been in dialysis for 8 yrs & still have trouble cannulating sometimes. It's just like some of the others have said, some days I do very well & then there are other days when it seems like I can't get any of them right. One tip that my clinic manager told me a few years ago was to hold the access firmly between your thumb & index finger of one hand & cannulate with the other hand, guiding the needle between where your fingers are holding the access. When I have an access that is not easily visible (like those dreaded new fistulas), it helps to hold it like that so it won't try to roll away from the needle. Don't be too hard on yourself. We all have different challenges. If someone is being arrogant about being asked for help, then they have the problem,not you.