Recommended Blood Flow thro Fistula Needles

babyboomerRN, RN · Dec 3, 2005

hi! welcome to allnurses! the blood flow rate depends on the needle size,may also depend on what type of machine you're using. 17gauge needles w/new access usually run 300bfr,16gauge needles may run 350 and 15 gauge needles run 450-500 per md order and facility p/p. hope this helps.

wmarat, BSN, RN · Dec 5, 2005

Hi!

I believe it depends on the unit policy. In Israel, a standart is 300ml/min through 16g needles.

jnette, ASN, EMT-I · Dec 5, 2005

We use 250-300 through a 17 gauge when the fistula is first being used. (first week)

300 with a 16 gauge for another week or so, then 400-500 with the 15 gauge or 14 gauge if you use those.

(we have two patients using a 14 gauge)

The Nephrologist/ Medical Director will determine the blood flow rate, (and will be noted on the patient's flowsheet) and which will most likey be what I've written above. :)

ch10 · Dec 11, 2005

We use 250-300 through a 17 gauge when the fistula is first being used. (first week)
300 with a 16 gauge for another week or so, then 400-500 with the 15 gauge or 14 gauge if you use those.
(we have two patients using a 14 gauge)
The Nephrologist/ Medical Director will determine the blood flow rate, (and will be noted on the patient's flowsheet) and which will most likey be what I've written above. :)

What venous pressure do you get using 17g at that pump speed? Do you use rope ladder technique in cannulation?

ch10

puddletown · Dec 11, 2005

Thanks for the info. Just wondering really about manufacturers recommended flow rates thro their needles as I understand that Gambro recommend up to 250 ml min in 17g needles, up to 350 ml min in 15g needles and for flows above that 14g needles are recommended. We are getting info from Gambro but some nurses feels go for as much as you can get. I know the big picture needs to be assessed (by nurses not doctors on our unit) but we understand there is evidence somewhere that shows trauma to red blood cells if the speed is too high for the needle size. This is what we're are trying to track down. However, really interesting to hear how other units do things, we generally have extremely poor access to work with and would never get above 450 flows! Mostly we run around the 280-350 ml min

jnette, ASN, EMT-I · Dec 11, 2005

Thanks for the info. Just wondering really about manufacturers recommended flow rates thro their needles as I understand that Gambro recommend up to 250 ml min in 17g needles, up to 350 ml min in 15g needles and for flows above that 14g needles are recommended. We are getting info from Gambro but some nurses feels go for as much as you can get. I know the big picture needs to be assessed (by nurses not doctors on our unit) but we understand there is evidence somewhere that shows trauma to red blood cells if the speed is too high for the needle size. This is what we're are trying to track down. However, really interesting to hear how other units do things, we generally have extremely poor access to work with and would never get above 450 flows! Mostly we run around the 280-350 ml min

Puddle..

Never heard that flows above 350 in a 15 g would hurt the RBCs... ever. That's why you use the larger bore.. to get the better flow rate. The better the flow rate, the better the dialysis.

Except for our newbies, our patients are all on 15 g needles, with two on 14 g. They all run at anywhere from 400-500 BFR, most at about 450, with several at 500.

Of course, those with 17 or 16 g needles, must be run at 250-300 respectively. Yes, with the smaller g needles, you CAN run the risk of damaging RBCs if the flow is too high. It's also hard on the new fistula.

I'll see if I can find some written info for you at work re this question.. give me some time, however. :chuckle

ch10.. with 17g needles we get a 250 BFR. We don't push for anything higher with those, as said above, it can damage the RBCs.

And what is "rope ladder technique"? Never heard of this term. :confused:

Would that mean sticking one spot, then next time across and slightly upward of the last stick, etc?

We might not specifically do that, but we do rotate sights. :)

dialysisalice · Jan 26, 2006

We run our pump speeds base on the Venous and arterial pressures. Try not to go above 240 mmHg for venous or -240 for arterial, that is when the RBC destruction begins. We run our pump speeds up to 500, if the pressures allow and the patient doesn't c/o pain. Catheters can only run about 350 though due to recirc.

Tish88 · Apr 9, 2012

Recommended:

BLOOD FLOW RATE VS. NEEDLE GAUGE

300 – 350 ml/min 16-gauge

> 350 - 450 ml/min 15-gauge

> 450 ml/min 14-gauge

How many of you out there are using 14 gauge needles and what are your thoughts?

rogue_maverick · Apr 11, 2012

@tish88

We use the same Qb for specific needle size but the largest needle we use are 15G. I haven't seen and used 14G dialysis needle yet.

I once had a patient on vacation from Europe and as I was going thru the endorsement papers, I noticed he was on a 17G needle with Qb of 400 mL/min. Pretty strange, but we had to explain to the patient that we needed to use bigger ones if we would maintain it on 400. We told him all the advantages of a higher bloodflow with a bigger needle, and he agreed on using 15G's. The patient has been dialyzing for 3 years already and I wondered why they were not using bigger needles back there. Turns out the nurses attending to him in Europe were not skilled enough, and would even rely on Doppler guided cannulation. Back in my head, I was thinking, WHAT?

Tish88 · Apr 11, 2012

@ rogue-maverick

It would be interesting to know what this patient's arterial pressures was reading on the machine. I am sure they were greater than -250 mmHg with a 17G needle at 400 QB. I just wonder how many cells they hemolyzed in the process?

Wow, having to use a doppler to cannulate someone that is really scarey! If I was the patient, I would be putting my own needles in!

rogue_maverick · Apr 13, 2012

His access doesn't even need a doppler. even a rookie dialysis nurse can cannulate a fistula that mature.

Our fingertips would be the doppler probe.