use of tourniquet

[student60]

Do you prefer to cannulate with or without tourniquet, and why, for your preference? Do you find advantages or disadvantages?

[KAT1994]

I use a very light tourniquet or use my little finger to apply pressure. This helps to inflate the inner diameter of the fistula and helps to reduce the chance of infiltration. I have had a few fistulas, especially upper arm, that when you apply even a light tourniquet it will shift the fistula to the side and infiltrate. This has been mostly with new, immature fistulas in the upper arm,and pts with flabby upper arms. I really encourage the PCTs to use finger pressure if possible.

[kladouci]

I often prefer the tourniquet but if someone has a "rope" in their arm I don't use one. I agree that if the fistula is underdeveloped that the tourniquet can be more harm than good. They shift too easily and are easily infiltrated.

At one point to you begin accessing your new fistualas? We have a protocol in place where we initially canulate our new fistulas approx. 6-8 weeks after creation. we start with the arterial using a #17 for 3 treatments, then we do 3 venous #17 for 3 treatments and then we use both # 17 for 3 treatments or until the fistula works well. We keep our pump speeds to 200 during this time.

I would be interested to hear how others do this.