Where do I cannulate?

[trinitas17]

I'm not a new nurse but I'm new to dialysis. It's the one thing I do not understand and I've asked my preceptor for advice but not getting a clear answer.

I understand AV graft and fistula, and how to assess them. What I don't get is where to cannulate the access? Is it where I feel the thrill?

My preceptor told me to follow the track marks but it's not always obvious. I notice that when others cannulate the access site, they usually go where there is bumpy areas. But from what I've learned it's not the best place to cannulate. Any advice?

[Shebfishn]

Hello

I have found Techs get very rushed and do not take their time on many occasions causing some of those bumpy areas and can cause pseudo aneurysms.  Take your time and make sure you are atleast 2 inches from anastomosis scar.  If there are alot of twists in access that can be somewhat of a challenge but it is OK to find new areas above other marks as well.  Patients like same area stuck due to it becoming tough and less pain but rotation is so important. 

Hope this helps