new to dialysis

Trauma Columnist · Dec 26, 2007

Aw Shelby - I'm sorry you feel that dialysis is hell! I'm an advanced practice nurse in a nephrology practice and I work with the chronic hemo pts. Not all are pleasant - lol!

I apologize that I can't help with the lido issue as in our units we only use the EMLA cream and/or ethyl choloride spray.

summer4me · Dec 26, 2007

Lidocaine administration should be in your policy & procedures at your unit.

Our P&P is 0.5ml-1.0 ml via TB syringe given intradermal like a ppd just under the skin at the avf or avg area you have chosen to cannulate. ONCE the needle bevel is under the skin, aspirate to make sure no bld return and inject at least 0.5 under the skin. Cover with a 2x2 and massage gently for a few seconds. Continue with your cannulation at or very near the injection site. Lidocaine burns on injection so don't inject too slowly. With patients that have been receiving it for awhile the area gets tuff (Scarred) & sometimes you feel you are injecting against a brick wall. We try to incourage pt's once cannultion is not difficult with their access to bypass the lidocaine. We use the emla cream also. We are going to the buttonwhole technique to be able to eliminate the use of either. The confidence you have in yourself with cannulating will come across as you get more confidence. Don't let anyone make you cannulate a new access and observe as much as you can. Listen to the access with a stethoscope also befor you attempt to cannulate. Hang in there. A more experienced staffer or trainer should be assisting you & a nurse shoulkd have taught you this. It is unfair for you to be trying to figure this out on your own. Hope this helps.

DeLana_RN, BSN, RN · Dec 30, 2007

Stupid question....What is the proper way to stick lidocaine...Im a new nurse in dialysis previous stepdown nurse for 4 yrs..At first i felt confident in pt care...Half the pts wont even let me stick their fistulas /grafts for fear. Im not getting the practice i need to feel confident...As for the lidocaine, i feel as though im not numbing them enough. Please help..i go back to hell tommorrow am.
thanks
shelby

Hi,

welcome to dialysis, I'm sorry you feel it is hell (I know, I felt the same way - my preceptors were definitely from there... in both chronics and acutes!) Anyway, there is a lot to learn and it can certainly feel overwhelming.

How long have you been training? If you give us more info, we can give you more perspective/advice.

As for the lido, you just inject it at the cannulation site like you would the PPD. Personally, I have always preferred to give lido, it gave me more confidence when sticking because I knew the pt would feel no pain. However, in my chronic unit it was discouraged (PCTs could not give it, most nurses could not be bothered to do so for them). Even now, in a hospital unit, most pts I ask decline it.

Check your P&P, our policy was to inject 0.1-0.3 ml at the sites. I normally used 0.1 ml, which was just as effective as larger doses. The important thing, often neglected, is to wait one minute after injection before cannulation.

HTH. BTW, the only needle stick I ever had as a nurse was from a lidocaine (TB syringe) needle when the dialysis pt suddenly moved his arm (you can just never let your guard down!)

Good luck to you, let us know if we can answer questions/offer support.

DeLana

P.S. Don't take it personal if many pts don't let you stick them yet. The know their access is their lifeline and are very protective. Once they know you better, this will change (and some will never let you do it - they have their favorites. Don't let it get to you.)

jnette, ASN, EMT-I · Dec 30, 2007

We never used lido and only very rarely EMYL cream or the spray. Hardly any of our patients ever complained of pain on cannulation, either.

And our patients never fussed about a new staff member sticking them. They knew that person had to learn, and were more than willing to give them that opportunity.. and were forgiving and encouraging if the stick wasn't the best.

Sounds like you all have a bunch of wusses in your units ! :rotfl:

GeauxNursing · Dec 30, 2007

We never used lido and only very rarely EMYL cream or the spray. Hardly any of our patients ever complained of pain on cannulation, either.
And our patients never fussed about a new staff member sticking them. They knew that person had to learn, and were more than willing to give them that opportunity.. and were forgiving and encouraging if the stick wasn't the best.
Sounds like you all have a bunch of wusses in your units ! :rotfl:

Well, sounds like you have a bunch of angels in your unit! lol.

jnette, ASN, EMT-I · Dec 30, 2007

Well, sounds like you have a bunch of angels in your unit! lol.

Yeh.. they really were a great bunch. I miss them all. I loved dialysis, I really did. Just couldn't deal with FMC though. They made my blood boil ! :angryfire

Sflowerssweeney · Jan 5, 2008

Janette, can you tell me what area you have worked in the Country? I have an interview Monday in the Southern MD area and wondered what it is about FMS that's a problem.

jnette, ASN, EMT-I · Jan 6, 2008

FMC is pretty much the same regardless of where one lives.

There are numerous threads and posts on this forums which go into a good bit of detail about the major megabucks monopoly companies.:)

Prvt Mack · Feb 1, 2008

Hello Jnette

I am interested in getting a Nursing Degree I just recieved my PCT Certification and am going to be lookig for a School in Georgia to attend while I can complete school. I am wondering what it is about FMC or FMS that is not so good maybe I need to change my specialty From Nephrology. I am good at what I do but havent had any success as a PCT finding a job. The need is for nurses so I am willing to invest in 2-3 years to get my degree since I qualify for the Hope Scholarship.

bluefabian · Feb 11, 2008

Well, we don't administer any pain medication at all here. Some new patients do came in with ethyl chloride sprays or EMLA creams at first, but none of that now. Although this is rather hard to say: they should be used to the pain by now. Some tolerate better than others. And a few with years of treatment still reacts like it's their first time. And I have a few pts that treat it like nothing when a failed cannulation occur, even when we adjust the needles and such! Really salute those people.

But be mindful, that it's painful. And say sorry if it hurts. Never scold the patient for being fussy or complainer. It's not good for the PR especially when you will be seeing them for a long, long time...

And be patient. It takes trust between them and you. I know some of mine takes months to establish.

Good luck!!!

errosmith · May 21, 2008

We never used lido and only very rarely EMYL cream or the spray. Hardly any of our patients ever complained of pain on cannulation, either.
And our patients never fussed about a new staff member sticking them. They knew that person had to learn, and were more than willing to give them that opportunity.. and were forgiving and encouraging if the stick wasn't the best.
Sounds like you all have a bunch of wusses in your units ! :rotfl:

A pts access IS their lifeline. I would always let a newbee draw venipuncture but never, never let a newbee practice on my lifeline. Thats just not pudent. Some pts indure many surgeries to get an access to work in the first place. A wrong stick could end that in minutes. I would never call these pts "wusses" as they have been through much more in their dialysis life than most have in their life without dialysis. A pt can only forgive the screw ups for so long and then come to realize, enough is enough. Units have other ways to teach their staff without putting the pt in harms way as a lab rat. Staff should not have to "learn" how to do their jobs at the risk of ending someone elses life.