new to dialysis

[shelbykel]

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

[bluefabian]

Please be minded that if a staff, a new staff never tried on a patient... then how can he/she be able to get a good line? I am all in the way of letting newer staffs performing cannulation under my supervision. If they don't try, how will they know? We as good, skilled staffs cannot be there caring for you forever. And before we left, we better train them as much as we can. With the high turn over and resignation of nurses of any discipline, this can't be helped.

There are a whole lot of different arterial and venous variations for each patient. Different depth, different angle and so much degree of difficulty. And these settings don't stay forever. It's not about knowing one theory of practice and applying to all tasks. Over time, even the most experienced nurses will have to 'experiment' in order to get good, clear line. And never do we treat patient as lab rats.

We as nurses understand the hardship of going through temporary catheter while the AVF matures and working, the cost incurred for a new formation. That's why we are so very careful in doing so.

[errosmith]

Quote

We as nurses understand the hardship of going through temporary catheter while the AVF matures and working, the cost incurred for a new formation. That's why we are so very careful in doing so.

I do believe that you have an idea of the hardship of having a temp cath placed but you do not have the knowledge of how it actually is. Only the pt has that knowledge. Personally, I have had 6 temp caths placed in a period of three years, three arm mappings, two fistula surgeries, one graft and two de-clots in the same arm. After all this, nothing was workable. I was advised that any future attempts at a fistula would be in vain.

Not all fistula will mature and not all pts will have the choice to have a fistula vs a catheter. After three different doctors I did attempt another fistula in the right arm and it is now maturing. I will not let a new tech stick this access for the first time...period. New techs can stick someone else who has a larger more mature access. They have no business attempting to stick a new access. It is not my job to make sure they learn how to do theirs. And its the companies job to insure that pts lifelines are not damaged beyond repair in order to train their staff.

Pts should be informed and asked permission for a new tech to stick a new access. Complications of a poor stick should be discussed with the pt and only then should the pt give permission for such a stick. Standing near the new tech and directing a cannulation is not going to make a bad stick any better. A life time of having a catheter stuck in your chest is not a consolation of being a good trooper and training the new staff.

[Kanani_Ikike]

Errosmith, I just want you to know that I agree with most of what you have to say. A person that is not in ESRD does not and cannot understand fully why patients are wary at times. I know that if it was me, I wouldn't let anyone that was inexperienced stick a brand new fistula. However, I also can see the other poster's point of view, too. What if all the new staff were never permitted, by any of the patients, to ever stick them? Where would we get new staff to replace the experienced staff when they retire? And there is a great shortage of people going into hemodialysis.

But, I can emphathize with you and the reservations you have. I guess it's a catch-22 situation. All I can think of in rationalizing letting new staff gain experience with sticks is the situation of home dialysis patients. You know when they first learn to stick themselves, they are new to cannulation. And just like new staff, they had to learn to do it. But, I totally can see your point of view.

[Squid-UR]

Sad but true a lot of dialysis companies have become difficult to work for!! When I was a PCT and looking for a new job I found that most units were not interested in if you were certified of not. Sure they all thought it was nice but did not compensate for it!!

Good luck finding a job!!!

BTW...DaVita isn't any better than FMC

[GeauxNursing]

I agree that newbies should not be sticking new accesses. it just isn't good practice. the more experienced ones should do the cannulating. i started out with well developed, can't miss 'em fistulas and grafts. as my experience and skill grew, so did my clientele, if you will. it is true that you can't just tell someone how to stick a new fistula. they have to know how to do it. the angle, the depth, etc.

and let it be said that people should not assume just because someone is a nurse, they are the "go-to" sticker. sure, nurses can cannulate. but the techs are the ones doing it day in, day out. usually. in my experience.

i see both sides of the discussion.

it is good to have Error's viewpoint in these discussions, as someone who experiences what we do, day to day.

[nlhrn2]

FMS FMC???? What do they stand for?

As for the Lido,,we had 3 pts code and die within a few min of eachother about 18yrs ago from the lido,,miss read bottles in the unit,,thought it was heparin,,so I'm told,,I was in Nsg school when it happened,,made me scared to go into hemo!!

Now nothing but EMLA