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)
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