I often close my eyes and just feel the fistula - if I try to find it with eyes only I may miss the stick, but when I KNOW where I can feel it, I usually hit it every time. Use a tourniquet and maybe even put pressure above the area you want to stick with your finger to make that vein pop up. Don't pull the skin too taut as you can actually flatten out the fistula and make it harder to stick. The more you practice the better you get! You'll also develop what works for you to make sure you are successful. As far as removal, put the gauze on top, place a finger lightly where the needle exits the skin and pull. It doesn't matter if it bleeds a little as long as you have a finger directly over the hole. I agree with diabo, RN that pulling needles without coring the access is hugely important. Also ask for feedback from your patients. Ask them if it hurt when you put the pressure on or if you put pressure on too soon. They will tell you the truth and will respect you for asking. Vascular access is one of the most difficult part of this job and you will become proficient!