Nerve pain with cannulation

[GeauxNursing]

Home hemo pt of mine is highly sensitive to cannulation. Tried the creams, sprays. Currently uses Id lidocaine (i know). Tolerates the stick okay I suppose. Last 2 treatments he had described burning, tingling all up and down access arm, increasing as treatment ticks on. It has happened occassionally with his last nurse as well, hitting that nerve (i presume?) and he practically jumps out of the chair. It was all I could.do to get the needle.out without him pulling back so hard and prematurely dislodging it. I know he's sensitive, but I also know that there is not much I can do with nerves located at the access. Trauma, looking for your ideas here, what are we looking at? Meeting with surgeon to discuss moving access? Is there any type of surgical procedure that can silence the nerve or something? I can Honestly say in my 10 years I haven't had such a case. I identified "the nerve area" about 2 weeks ago and stayed away from it. But last night I found.another area, same problem. We cut.tx short last night bc he refused to adjust needle or.be restuck. Tonight it went in okay but after about 30x minutes it started creeping up on him and he asked to end tx, again.

I asked.him if he thought I was sticking him wrong and he said no, it's just one of those things that happens to him.

Thoughts please?

Thanks.

Let me.add, it is a forearm graft, inner aspect, running horizontally. Arterial distal, venous proximal.

[nutella, MSN, RN]

It sounds to me that there is perhaps some nerve damage involved. I wonder if when they did the graft surgery they came close to a nerve or injured it or scar tissue. Anyhow - I guess the best option is to have the patient seen by the surgeon who performed the graft surgery and check the access. If it continues to be a problem he may need a graft in a different location.

[traumaRUs, MSN, APRN]

Agree with above poster. If changing needle placement doesn't work, might also try shuntogram to check for stenosis. Surgeon (and pt) will want to exhaust all options prior to removing graft.