TIPS ON CANNULATING FISTULAS AND GRAFTS.

[aarnigo, ADN, RN]

Hello!

I'm a new grad starting my first nursing job at an outpatient dialysis unit. This might seem really silly, but I need help cannulating patients with fistulas and grafts. Sometimes I get them, and sometimes I don't - some other time I just need to push the needle further to get a backflow. I had instances where patients have weak pulses and backflows won't show initially. I guess my confidence is just at a low because of this and would like to hear tips on how to better stick patients.

My preceptor have taught me to hold the fistula/graft - i've seen people pull the skin taut with their thumb and index finger. Sometimes I wonder if I'm pushing the needle way too superficial or if I'm not pushing it deep enough to reach the access.

Even with removing the needles, I have a hard time timing the pressure with the gauze and the removal of the needle while engaging the lock. I know it's going to take a lot of practice, but I would like to hear what everyone has done to make these tasks easier for you!

PLEASE HELP! :(

[diabo, RN]

Practice practice. Your smile and confidence will assure your patient. Removal technique is most important and is not always emphasized enough in my opinion. It needs to be taken out as straight as possible with no pressure until it is out, or the razor sharp needle can tear the vein . Even a slight tear can greatly prolong the clotting time. As your confidence grows you will speed up and it will become second nature.

[Zeek, LPN]

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!

[Twinmom06, ASN, APN]

I worked with people that were "feelers" - they preferred to feel a fistula. I was a listener - I would follow the entire fistula with my scope to find the curves. You can also make sure you're in the vessel by attaching an empty syringe and pulling back - if it pulls and pushes without difficulty you're golden. Also if its a fistula ALWAYS use a tournaquet. Good luck!