Infiltration

[BJZMom]

I have been a dialysis RN for almost 5 months. When cannulating a patient last week I caused his AV graft to infiltrate. The swelling and bruising were pronounced. The needle was removed and ice was applied to the site. The patient obviously expressed a great deal of anger accompanied with verbal insults. I asked an experienced technician to cannulate in a new site once the bleeding stopped. I am finding that my confidence is totally shot and I frequently ask for assistance with cannulation for fear of repeating this scenario. How can I work through this? I have asked other nurses and techs for methods to prevent a repeated incident in the future. Everyone just says that "sometimes it happens!"

[km5v6r, EdD, RN]

I have been a dialysis RN for almost 5 months. When cannulating a patient last week I caused his AV graft to infiltrate. The swelling and bruising were pronounced. The needle was removed and ice was applied to the site. The patient obviously expressed a great deal of anger accompanied with verbal insults. I asked an experienced technician to cannulate in a new site once the bleeding stopped. I am finding that my confidence is totally shot and I frequently ask for assistance with cannulation for fear of repeating this scenario. How can I work through this? I have asked other nurses and techs for methods to prevent a repeated incident in the future. Everyone just says that "sometimes it happens!"

Some times it does just happen. What did you do to cause the infiltration? Have you ever seen a picture of an explanted graft? I have two really good photo's of a graft that was removed after 2 years. The ends of the graft are great but the middle looks like chewed spagettii. The pt insisted his graft be stuck in the same place every treatment and the walls weakened. Sometimes the pt will move and the needle with shift. Last but not least is the fact that just because the pt is laying the blame on you doesn't mean you did anything wrong. Unfortantly I have seen a few people who seem to be able to sense the less confident and prey on it. I have seen people that the more upset the nurse became the more insulting and upset they became. You did not set out to cause this pt pain or difficulties. Keep practicing and yes that means practicing on pt's. The dummy arm doesn't cut it. Don't let them see you are afraid. At 5 months it is not possible to be an expert at sticking. You will get through this.

[diabo, RN]

I ran one yesterday that infiltrated after 2 hours. It happens and we learn and continue to go forward to help our patients. You may have nicked or went through the back side of the vessel, who knows. Fistulas can be strange animals, but you didn't do any damage to it. The swelling and discoloration will go away. Professional nurses smile a lot, so be happy. Your technique will continually improve.

Steve

[kdhnursern]

When I was new at dialysis, I had a patient come in and show me the biggest discoloration over his fistula and angrily say "If you ever do this to me again, you won't ever stick me again!" I had only been sticking for about 5 days. I went out into the hall under the pretense of getting something, composed myself, and went right back in and stuck him like nothing happened. I felt like it was like falling off a horse, you just get right back on and ride it. I did learn a great lesson. When there is someone new to cannulating that I am mentoring, I give them a great pep talk and boost their self-confidence. And I never leave them alone with a difficult patient. Later on, I'm one of the first to let them know that it can happen at any time for who-knows-what reason. Monday, my facility manager cannulated a new fistula and the patient rolled his arm several times and it infiltrated after about an hour. Big bruise! Yesterday, I cannulated him and it infiltrated right away. I think we'll let it mature a little longer. I always tell the patients "If we had x-ray vision, we could see inside and see what the problem is."

Hang in there.

[BJZMom]

Thank you for all of your replies. I appreciate your support. This ole girl realizes that she just has to brush off her shoulders and continue to tackle each patient with the upmost level of confidence.

:pumpiron: