Pulling Cannulation Needles and Labs

[WeakAnkles]

New to dialysis and had a few questions!

What's you policy on pulling needles and why? Is it one at a time or both? I see people pull both at the same time and use clamps for pressure. Would this increase their risk for clotting the access?

I know what our policy says, but I also know what I am seeing. Is this a case of the "ideal world" verse the "real world" usage? Is there any real risks involved to the patient by pulling both at the same time?

Also, I see labs being drawn from the port on the arterial line. Is this OK? I was told that there's saline in there and the data is not accurate. Is this true? I know we use central lines for lab draws, after wasting first. Does the line clear of saline quickly once the treatment has started?

Newbie here needs help. I only seem to get conflicting info from the workplace. I can read the policies, but also observe the reality of it well.

[Lacie, BSN, RN]

We pull only 1 needle at a time and the pt must hold. If they are unable to hold and we cant hold for them then a clamp is used but no more than one at a time. Our clinic doesnt allow pulling 2 needles at same time due to risk of not only bleeding but you can easily clot that part of the access between the 2 locations. Think about it from point A to point B with possibly no flow between them. Also the potential for bleeding when you pull both. I have been in clinics that do both but it was against policy yet was practiced. Time constraints shouldnt put your pt at risk. I encourage my staff to consider safety and what's in the pt best interest first. Also we manage to get our change overs done timely and without the rush. I found the more we try to hurry the more mistakes get made and pt's do notice whats going on around them. We draw all our standard labs prior to ever hooking them up to any lines with exception of the post. We only draw the post from the art line port closest to the pt once we are sure there is no chance of recirc blood in the line and the UF is off. Central lines we not only clear the cath first but draw 10ml of blood off then draw then give the blood back to the pt. Hope this helps. Best thing to do is check your company policy and follow it. I know it's hard not to "follow the pack", especially when you hear things like "this is the way we always do it", but I know in the long run it's the patient it effects when labs arent drawn properly.

[WeakAnkles]

I appreciate your response, it helps clarify a few things for me. I too desire the patient's safety first. I agree with others rushing, it only seems to create more chaos than is needed, and less gets done as a result.

[Kelly_the_Great]

In regards to pulling needles, I've not seen a policy that addresses this issue and I'm wondering what you guys do/see in practice..???

We have a few patients who prefer to have a bandaid placed over their insertion site when the needle is d/c'd. Then the gauze placed over, secured with tape and the pressure applied.

In practice, this has been very difficult for me to accomplish. What they have you do is partially withdraw the needle then place the bandaid over the insertion site while it's still in, then put the pressure gauze over the site, fully d/c the needle, then apply pressure.

This just seems so risky to me. I mean, sometimes, particularly if a patient has a problem w/bleeding, they bleed around the site, then also, I'm afraid the needle will become dislodged before the pressure gauze is ready or that a portion will become attached the bandaid and cause damage to the access because it doesn't pull out smoothly.

The theory that one of the patients has espoused is that the bandaid is sterile and thus a better option than the nonsterile gauze. However, I feel like since it's not being opened in a sterile field, and because our gloves are not sterile then it's not really any better than gauze.

[Lacie, BSN, RN]

I put a sterile 2x2 quartered under the bandaid. I do pull the needle out just slightly to dislodge any sticky residual left from the old tape from during treatment. I pull the needle by the hub rather then by the wings then apply pressure to the site when the needle is completely out of the site. I found pulling by the tubing/hub and not the wings tends to let it slide out much easier then same angle it was placed. Research is being done stating it may be better to insert this way also in lieu of the wings. I hold for a minute myself before I turn it over to the pt to hold. Sometimes if I have someone I know will tend to bleed then I put a betadine prep under it instead as it seems to help slow the bleeding process. Super stoppers are great also as you dont have to use all the other gauze with it. I've had good success with them with my bleeders. Either way I still put 1-2 nonsteril 2x2's over the bandaid until I'm sure it's well clotted as they can remove these anytime they desire leaving the bandaid which they find more appealing when they have to go out for other activities in public. Less questions from people when they dont have huge bandages taped across there arms out in public. I try to put myself in thier shoes and what I would want and my answers usually come out pretty much the same as what they voice.