Title: Techniques to improve cannulation & patient self-cannulation education
Abstract:
Challenges to patients choosing to home hemodialysis (HHD) are fear of needles and learning self-cannulation. Nurses can reduce a new patient’s anxiety and pain that often occur in anticipation of andduring cannulation of their arteriovenous fistula or graft with large gauge dialysis needles. Nurses can gain better control and improved touch sensitivity when they use a technique called “Touch Cannulation.” With this approach, the nurse holds the dialysis needle 2 or 3 inches behind the wings when they cannulate a patient’s vascular access. Nurses can teach patients how to self-cannulate using a technique called “Tandem Hand Cannulation.” For the first few cannulations, the patient puts his/her hand on top of the nurse’s hand as the nurse cannulates the access. This allows close visual and tactile observation of needle insertion. Next the nurse places his/her hand on top of the patient’s hand as the patient self-cannulates. This enhances the patient’s sense of competence and skill. Teaching staff these advanced cannulation techniques will reduce patients’ pain, improve preservation of the fistula and reduce access complications and expense. Nurses can use a technique called “Cushion Cannulation” when teaching a patient to self-cannulate or cannulating a patient’s vascular access. She would do this by placing a cushion under the patient’s arm to allow better visualization and reduce the chance of infiltration. A side benefit for the nurse cannulator is reduced back pain. Finally, in this presentation there will be a step-by-step description of how to remove scabs from buttonhole sites prior to cannulation, which has been shown to reduce the risk of vascular access infections.
Audience Take Away Notes:
- Tap cannulation, a technique that can be taught to patients to overcome needle fear
- Using touch cannulation can improve accuracy and reduce infiltration of AV fistulas
- Tandem hand cannulation can be used to teach patients to self-cannulate
- Cushion cannulation technique provides better
- How to remove buttonhole scabs prior to cannulation to reduce risk of infection
