How to cannulate without pain?

[hazyblue]

I'm working for almost 1 year in HD now and still I suffer rejection from patients, one of which is that insert needles painfully. I'm not good with deep accesses either so I really want to get this right. *sigh*

We don't use lidocaine in our unit. We just prep the access and stick the needle. They rarely complain with other nurses but they usually complain to me. I observed that old insertion sites are less painful but that is not good...

My senior once told me to insert slowly but that doesn't work for everybody either...

How do you insert your needles? Is there a certain angle that I'm missing here? Or I'm just the nurse with those heavy hands? God forbid that, I'm now considering a career change...

Tips? Anyone?

[Chisca, RN]

Venous needle is removed first, then the arterial needle. The blood in the access is a mixture of arterial and venous blood because it is an artery (high pressure) connected to a vein (low pressure). Think of the flow as a river and you want to work your way upriver removing needles. Everytime you pull a needle and apply pressure this increases pressure in the access upstream of where your finger is at. If you pull the arterial needle first when you go to pull the venous needle you will be causing an increase in pressure upstream and the arterial site will begin to bleed. Start downstream and work your way up.

[hpm0]

I am not a nurse. I am my husband's caregiver for home hemo, using NxStage equipment. When we first "graduated" from training at the end of May, I was great at cannulating his graft. The nurses were amazed, and I was confident that what is tough for most caregivers would be a breeze for me. Not so much anymore. The other evening, the insertion of the arterial needle went fine, but with the venous needle, I couldn't get a flash, no matter what I did. I tried repositioning the needle, moving it a bit to the left and right, up and down, even flipping it. No go. After about 10 min., i gave up, pulled that needle, found another spot and that worked ok. But because this has happened before recently, I am now having a crisis of confidence. We are to treat tomorrow, and already I am wondering what I will do if I have a problem again. The local Fresenius clinics do not operate on weekends, so what happens? Take him to the hospital and have him dialyzed there? Would they do that without admitting him? How do I get my mojo back?

[Chisca, RN]

Use a tourniquet. Also see if you can get your provider to give you a prescription for ethyl chloride spray, Fast acting topical that numbs the skin. If you can't access the fistula take him to the hospital. They can evaluate the fistula to make sure it is working properly and yes they will dialyze without admitting.

[nephnurse13]

Cannulating an AVG or AVF has absolutely nothing to do with giving an injection, IM or otherwise. Completely different technique all together.

[nephnurse13]

It's because you're new. Has nothing to do with fast or slow, pulling the skin, prepping the access. Dialysis patients across the board like experience. Be confident every time you cannulate and they'll come around. Distract with general conversation. A 15g needle is never going to feel good. Ever. Just be have patience and be confident. I've been a charge nurse in the same dialysis clinic for 14 years.

[Twinmom06, ASN, APN]

Use a tourniquet. Also see if you can get your provider to give you a prescription for ethyl chloride spray, Fast acting topical that numbs the skin. If you can't access the fistula take him to the hospital. They can evaluate the fistula to make sure it is working properly and yes they will dialyze without admitting.

I thought she said he had an AVG- we were taught not to use a tourniquet on a graft. Also the contract for our acute unit strictly prohibits dialyzing without admission. Of course we have our FF's that sign out AMA once they get to the floor after a treatment.

[Tina_pai]

I've been working on a dialysis unit for 7years...Try not to put the tourniquet so tight and not so far from the puncture site. More so it can cause pain if you hit the vein's wall. Thus, you have to assess the patient's vein (the width, length and if it is too deep or not) while puncturing, never stop assessing the vein. You have to make sure that the needle goes smoothly, or else, you're not on the right track of the vein =)