Brouwer DJ
Cannulation camp: Basic needle cannulation training for dialysis staff

Dial Transplant (Nov) 24:606-612 1995

This is one of the few articles available discussing tips on how best to cannulate fistulas and grafts. Among the useful hints are methods to distinguish proper direction of flow. Working with the Transonics ultrasound monitor, we identified several patients in units where the needles had been placed in reverse order (due to failure of communication with the operating surgeon). Tips to determine direction of flow include listening for the loudness of the bruit after slight finger compression on both sides of the compression, looking for flashback through both needles with and without finger compression, and observation of pressures after graft compression; normally with the flow at 200 ml/min, the venous pressure will fall on digital graft compression. Needle placement in anterograde vs retrograde direction is discussed, but without mention of the strong European preference for inserting both needles in the downstream direction (so the flow will help close the entry flap after the needle is removed). A 180 degree rotation of the needle bevel after insertion is advocated to minimize backwall injury, although the paper cites another source criticizing this method. A "blue thumb vs. red thumb" method of helping identify and recall flow in forearm loop grafts also is noted.

Comment: All in all, this is a very useful article. More papers of this type are needed, along with formal research to identify the best methods of graft cannulation. (Daugirdas)

To go back use the BACK button on your browser.
Otherwise click on the desired link to this article below:
Basic hemodialysis : Dialysis procedure: tips