Scribs76

You can always ask the patient to cough a few times and sometimes you'll get your access to pulse strong enough to palpate it and it's course. Did not always work but in a pinch it might buy you a little extra info. Ive been doing HD for 13 years or so and still don't hesitate to ask someone else for what they feel. Sometimes stripping back for a minute to reset my fingers helps too. It sounds dumb but if I've been looking on a new AVF and am just not positive I'll either do this and reset or close my eyes and feel very lightly on the vessel, almost with minimal pressure. I'll just do this and vary my pressure until I can visualize it in my head. When needling I find some newer staff might go just a touch too far with their needle too and nick the back side. I'm not sure if they don't let off pressure once in the vessel or if a but if anxiety hits them. I still can feel a patient's anxiety effect me and some days I just know I don't have 'it' and defer to someone else. One other stupid sounding tip but I used to watch a lot of the Dog Whisperer. His whole thing about how the nervous owner's tension on the leash transfers to the dog and makes it anxious as well sounds corny but I think of it when I've had a bad day or just don't feel confident. I try to see the needle as the leash and it makes me focus on not gripping it too tight because that will make the fistula tense up (not really but whatever works works). I worked with really good mentors when I began and they never hesitated to needle of I could not get one but I always appreciated that they encouraged me to try when safe, obviously. You just learn the feel by doing. The little tells and that tiny almost non-existent push back by the fistula that leads you where you need to go only comes by trying and watching others when an experienced needler is required.