More than 70% of Dialysis patients contend with Chronic Pain. A key area that many patients are concerned with is getting 'stuck' when being placed on the Dialysis Machine. Some patients skip treatments entirely or attempt to get a specific technician to put them on the machine. If one tech is a popular 'sticker' then this can cause delays for other Technicians and patients. If a Dialysis patient does not get put on the machine correctly then they can be in severe pain, cause blood pressure issues, make treatments more complex, and many other additional setbacks that can be challenging for the patient as well as the technician. Plus, the Patient Care Technician often feels terribly that their patient is not experiencing a more comfortable treatment. Hence, a great way to make Dialysis Treatments smoother with fewer difficulties and pain is to make sure that we get the stick right. No matter how long you have been a Dialysis patient or a Technician, it is always good to have a quick refresher for improvement. Review below:
The Vascular Access is considered to be DIalysis patients' Life-Line. It must be respected, assessed, and maintained in order to prevent access failure. Here are a few tips on how to best stick a patient's Dialysis Access to ensure less pain, mistakes, infiltrations, damage, and additional complications.
1. Holding The Needle: The needle should be held by the wings with the bevel facing upward. This places the cutting edge of the needle on the skin which facilitates cannulation (sticking) through the skin, subcutaneous tissue, and the graft (an artificial blood vessel used to surgically connect an artery and vein) wall or fistula vessel wall.
2. Feel For The Fistula BEFORE Sticking: Often it is tempting when you have several hundred stick under your belt, for the Patient Care Technician to just use an 'Eye Test' to judge the best sticking location for sharp needles. Patients often also like this because they feel as though it gets the sticking over with sooner and they do not have to think about the pain. This, "Do it quickly" strategy seldom is effective and can do more harm than good. Take a few minutes to feel where the AV Fistula is in the patient's arm (every arm is different) and identify where the best 'Sticking Locations' are. The needle should be held at a 25 to 35-degree angle for cannulation of the Fistula.
3. Always Wear Gloves: Sorry in these pictures, the Technician is not wearing gloves (we will write him up for you. Lol). The fact is that gloves help protect the patient from infections which is the second leading cause of death. It also protects the Patient Care Technicians which is also important. Long-story-short: ALWAYS wear gloves and change them whenever you leave a machine. Also, the needle should be held at a 45-degree angle for cannulation of grafts. The purpose is to create a flap in the graft wall at the puncture site which forms a type of valve when the needle is withdrawn.
4. Sticking Without Pain: Once the needle has been advanced through the Graft or Fistula wall, ask the patient if they feel any pain. If the answer is no, then you have a good stick! A flashback (blood pumping back and forth in the needle) should be visible. If so, continue to advance the needle no more than 1⁄8 inch (0.3 cm), level out and advance the needle slowly up to the hub(the end of the needle). If not, you may need to pull back and try again. Again, it is important to check for the thrill (the pulse of a Fistula or Graft). If you cannot feel it, don't stick it!
5. After The Stick: After the needle is properly placed, secure it with a 6" piece of tape that will cross over the wings in an "X". A band-aid should then be placed over the insertion site. Check to make sure that they patient feels no pain. This last check-in question will ensure that the needle is not too close to the vein wall which can be painful and leave lasting damage. Moreover, if patients ever feel pain, then they should let the Patient Care Technician know, even if it means they have to say “Ouch!” Communication is critical.
Source: WkiHow. Adapted By KidneyBuzz.com