Heres my question, I've been at my clinic for a year. I had no experience with needles whatsoever until i began working here. I had never even performed a d stick. I am a tech, and i tell you, i'm about to just throw in the towel with dialysis because cannulation for me can be sometimes very difficult. You know the sad part, I absolutely love dialysis, every aspect. I tell you sometimes I feel like a deer in headlights. There are days when I can stick some of the toughest pts with no problem and then the very next time I try, no success? There is one fellow, no matter how hard I practice I just can't get him. It makes me angry because I compare myself to the other techs and they usually have no problems with him. I averaged out that out of the 17 accesses that we have at our facility, i can only cannulate 13 of them withoutever having problems. Am I a bad cannulator? i know that i been there a year, but I feel that i should be doing better than that by now. Will i get better with time, or should I just accept the fact that I'm lousy at cannulation and maybe dialysis isnt for me? BUT I LIKE IT SO MUCH
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.
Many recommend the use of a tourniquet to stabilize the site. RenalRuth:nurse:
Hey Lunden, I thought I'd drop you a line and see how you are doing today. You know things seem to be going a little better at work lately, knock on wood. I thought of u yesterday when I decided to stick one of those pts. that I usually never get. I made myself remain calm and I remained totally focused on every aspect of the process, the bottom needle always goes in with no problem at all, its that top one that is the tough one. When I went in for the top site, I started out real slow. At first, I felt as if I was not in the fistula, so I backed up and changed directions just a hair, no flashback. I then REALLY concentrated and I felt of the access several times I gripped the fistula with my thumb and index finger firm, lined the needle up between the two fingers, and BINGO I got him! I then had a after thought after it was all said and done. Since the top site is so small and narrowed, I can always stick the bottom site with the needle facing down bc the bottom site is much wider and bigger, and then It would allow me to stick the top needle not so high up where the narrowed vein is. I am sure the needles would be far enough apart that it wouldn't affect his adequacy or recirculate. Thanks so Much. Lacey
good job! that's how it is with me too. i'll get that arterial but that venous can be something else. you did just what i would have done. i sometimes even flip the needle but i make sure to flip it back before i pull it. thanks for emailing, i'm going crazy wondering if i got in this nursing program. i heard letters go out 2morrow. we must work the same weekend,i had 2 work yesterday 2. have a good one 2morrow if u gotta work. kim
Lunden, I'm on my lunch break at home, so I thought I'd drop u a line. I am SO sure you'll get in with no problems. Look at what u have to offer you have worked as a dialysis tech for 8 yrs, and you really know your stuff. I know people who had been accepted to nursing school right out of high school with no nursing experience at all. You'll get in and they won't even doubt your application when they see all the credentials and experience you have to offer. I'd just try to focus on other things until ur acceptance letter comes in. Yeah, I know easier said than done. Before I sign off, I got another question about cannulation for you since ur so smart. Since I had good luck with that other pt. on Sat. I thought I'd try to work on one of the others who is hard for me, but I scared. His is hard to figure out. He has a graft in his thigh, I hate that. Well, the inside site is a piece of cake, the outside is vicious. Since his is a horse shoe shape around his thigh, his skin is real tough like chicken skin, and the graft dosent pertrude out any so there is nothing to grip on to and its hard to see. I always feel, but he claims the direction is toward the belly button. So naturally I listen to him, thats where I start. I never feel a pop even when I do get in everyonce in a great while, and when I don't get in I get a small flashback, but when I try to pull back on the syringe I cannot there is lots of resistence. Am I even near it when this happens. His outside site is so curvy. Do u have any advice? Oh and by the way, I betcha we do work the same weekends, cool.
hey, thanks for the encouragement 4 nursing school! as for the graft, it seems like u may not b n. and if u can't pinch or grip it, that makes it work. i would listen with my stethescope, place my finger right where i feel it and go in right there. u may or may not get it. i had a 17 year old sat. and as soon as i went in he wouldn't let me adjust and just wanted the needle out, so i took it out and just started again, so it's like u never know what will happen. but try it that way and see if it works. if it keeps resisting there may be clots in the needle also. practice makes perfect, the more you cannulate the more you'll know if it's possibly scar tissue in there or a clot, u could be against the wall or off 2 the side. chat with u later:nuke:
Hey Lunden, How are u? Thanks for the advice on the graft I will try it. I didn't have a very good day today. Remember when u told me that u felt that ur facility had favorites when it came to techs. I really don't know how to take this but we had a new girl come in today that is going to start next week. Well, the senior tech, who is great by the way, told the director that she is tired of training everyone in the facility and that the techs that work there all do a good job and that she thought that is was time that someone else do their share. Lunden, I know that i do a good job and I was excited and anticipating that she would ask me, well she did not. The girl that she elected to do so, who wasn't even working today may I add. She totally bypassed me and filled in the training log for the one who is arrogant and thinks she knows everything to train this girl. My feelings are hurt and I don't understand why the director does the things she does. The arrogant tech has only been there a month longer than me so she cant use expereince as an excuse. I tell ya, i just feel like a shadow in that place, I feel so unappreciated. Last time, we had a new girl to train and I wasnt able to train, I asked the director why and that I would be happy to, and I asked if there were any problems that I was unaware of. she said no, everything was fine. I do feel like a shadow. The pts care about me and I care for them as well. But I have a hard time knowing that my services are appreciated. Sometimes, I wonder why I even bother?
try not 2 feel bad. i've been doing dialysis 4 14 years, have worked at over 5 diff. clinics (even when i moved to atlanta, i got that job over the phone) worked for the "pool" where they send u 2 diff. clinics 2 work contingent, certified, waiting 2 get n the nursing program, trained by veteran techs. self taught myself theory, u would think after all that, that i would be the "go 2 person" but guess what, i'm not. there are 2 techs, one whose only been doing this 6 years, was hand picked by our FA 2 b the "Ambassador" and (don't even know what it is) but she was sent out of town and came back bragging, the other tech, well they go to her 4 EVERYTHING, she's only been doing this for 4 years, and yet her and the other tech trains EVERYONE and i'm the actual PRECEPTOR, sent me out of town and everything, see what i mean? i use to be like "what the hell" and i would feel very hurt. i still do sometimes, but hey i've decided i'm tired of letting them ruin my happiness and i stopped trying to figure out NONSENSE!! when i'm at work i proudly wear my CERTIFIED badge and i'm just basically like "whatever"
Thanks so much for the advice Lunden. I will do my best but it still hurts. In the back of my head i always wonder is it my performance or is it bc i dont suck up? I love my job and I treat my boss with respect, I try to approach her as I would a friend, I try not to be intimidated by her bc of her status and I treat her as kind as I would anyone else. Do u think it would be inappropriate if i asked her? Or maybe it would be putting coal in the fire? Who knows. All I know is that I'm begining to feel a unappreciated and looking forward to nursing school so that maybe one day I can possibly find a job that is not so much full of politics. I know that no job is perfect, but perhaps I would feel better in an environment that was more appreciative. OBTW, the arrogant nurse has her lips glued to the bosses but all the time. Offering to do this and that and run errands etc. Not that I mind doing things like that myself but my main focus is my pts, their well being and my own personal duties such as water room etc. I dont know why she is the favorite bc she'd rather run errands than do her pct duties which she waits till the last minute to do. maybe she should be hired as a secretary. She hardly talks to the pts. she's rude and says mean things in front of them. Beats me?
ha ha ha:D (her lips glued to the boss's butt) it's nothing you're doing. the techs where i work are just nosy and the other one is always running to her office telling her everything. they are just very very nosy and i'm not.
hi there, got my bad news today. did not get in the nursing program. the lowest gpa was a 3.7 i'm taking 2 classes over and one co-pre-req. one class was A&P, which i got a B in and the other is soc. which i received a C in. bummer:cry:
Lunden, i'm so sorry. since I am not in the nursing program yet can u tell me what the A&P course is bc I do not know. So did that hold u back bc you got a B in A&P bc I think a B is a good grade. As for your soc. class u received a C right? I know its frustrating and I would be mad too. Youve got what it takes, it just hard when you have kids and a full-time job and the whole nine yards believe I know, and I really feel for you. So are u gonna take these two courses over again for Spring Semester? And look at it this way, u can learn from ur mistakes so whatever parts of the courses u found difficult, u can know that for next time so u can work on those parts a little harder. And if u feel comfortable enough maybe u talk to ur old professors and discuss which parts of the class u had difficulty with and how to go about working on it. Since u still have ur text books for those classes, u can go over the parts u didn't understand and be one step ahead for next semester. Hopefully the textbooks won't change by that time bc they change so often. Thats what I would do If I were u. Id read the books and get a step ahead. You have till Jan b4 the SP semester starts so pace yourself. It's hard when u have kids too. So maybe when the kids go to bed for the night crack open the book and read for 30 min or so. I wouldnt try to read the whole thing in a week bc youll burn yourself out. If you need any more advice, I'm here. I check this blog several times per day especially if I think u may have left a message. Also heres my email address [email protected]. I'll talk to u later
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Many recommend the use of a tourniquet to stabilize the site. RenalRuth:nurse: