I wanna quit

Hoosier_RN, MSN · Oct 14, 2018

Unfortunately, you've answered your own question. Practice makes perfect. Also, remember that we all have spells that we can hit an access from the other side of the room, and sometimes no matter what we do, we couldn't hit the broad side of a barn! Don't be hard on yourself, we all have rough times, no matter what area of nursing. Take a deep breath, and know that this too shall pass. I know that I'm using many cliches, but they are all truthful. Also, I hope your still in an orientation (Fresenius offers 6 months, not sure about DaVita), ask your preceptor, educator, or a trusted colleague for some tips. Don't give up, you can do this!

Zeek, LPN · Nov 7, 2018

When I think I can't get an access, I close my eyes and just feel the access under my fingers, take a deep breath and only when I feel like I have the feel of it do I put a needle in. You will have days where you can't hit the broadside of a barn, but these will diminish. Overall, don't be hard on yourself. Acutes can be stressful enough without you putting more stress on yourself. You can do this, and yes, ask a preceptor or someone you trust to look at your Cannulation technique. Sometimes you change things without even knowing. Keep on trying and it will get better. Or so they say!! I've been in this field for 33 years and some days are just hard. Hats off to you for working in Acute Dialysis - sometimes the hardest place to be.

AlabamaBelle · Nov 12, 2018

I've been doing dialysis for 4 years, part pediatric and part adult. Some days you got it and some days you don't. My 2 missed accesses were with the same doctor who does not like me. I actually call for changes in patient condition (patient bleeding profusely after 45 minutes of pressure, to the NP who told me to hold manual pressure, like my fingers weren't already cramping, took another 45 minutes to control enough to bandage. 30 minutes for the upper access. Though he might want to know about the patient who coded (DNR) while on treatment. There were other factors in play and another doctor is in hot water for a bleeder that he refused to come in and check.

Be patient, you got what it takes. It's just like with IVs, you go through dry spells.

10GaugeNeedles, BSN · Apr 23, 2019

I’d say give yourself a chance. Don’t think you have to be in as soon as your needle enters the skin. If you haven’t actually penetrated the fistula, you are still good. Back the needle up a bit, visualize the relative position, reaim, and slowly advance till you get flash and pulse. If it helps, draw parallel lines along each side to give yourself a runway. Finally, you can try entering the skin first and then enter the fistula in a two step cannulation. There’s a bunch of ways to skin the cat. Don’t be timid. Also don’t be afraid to be in there. Once you’re in the skin, the pain is generally mild. It’s the skin that hurts the most. Get in there. If you aren’t in the fistula, relax. That was just step one. Take a deep breath. Visualize where the needle is, re-aim, and go to step 2.

BrantleyRN · Apr 23, 2019

Very good topic! When cannulating I always grab the access between 2 fingers on it's sides and sort of pinch it up. This gives me a feel and a visual of my target.

Then when I poke I do a hard jab to pass the skin and pop into the graft or fistula, once you see that flash, STOP.

Then advance very slightly so you are sure the tip is fully in. That is when I lay the needle down and advance it all the way.

Take a deep breathe, we all go through this, and even after you're fully confident you will have issues that will pop up, but the experience will teach you how to deal with those.

Good Luck!

-Brantley