Cannulation of AVF using wet stick

I started in HD 4 yrs ago and was trained to cannulate all AVF and grafts using a “wet stick” technique which involves connecting a NS filled syringe to the needle prior to insertion/cannulation. Our unit manager is very adamant that we use this technique and does not allow dry sticks as she feels that dry sticks lead to more problems and result in infiltrations. I have recently been moonlighting on a different unit and dry stick is the preference, so I have been experimenting with this and starting to see the positives of the dry technique, i.e.; more often a flashback is visible. I am curious as to what others’ experience has been.

Dear sueski,

I can only talk about this as a patient. For over 28 yrs I have self cannulated using the dry stick method. When I vacation, different labs may use the wet technique, but I have found the dry method to be very good. I have never had any revisions on my continuously working fistula which makes me a proponent of the dry stick method.

I’ve been in dialysis for 14 years and worked for many longtime dialysis crews. Sticking either wet or dry “no matter”, it is your preference. In our field we have to do what is best for the patients access and so stick how you feel the most comfortable! As for dry stick really only on transients or acutes you do not know, this will help for determing reversal of access! Hope this helped!!

my temporary unit, run by Fresinius, dry sticks ‘if you like the phrase’ & ‘bleeds out’ at the beginning of a session.
My usual unit ‘primes’ the lines * the needles with a small syringe attached, & have what I call a ‘normal’ method of washback.
Possibly the protocol of priming a needle reduces the chance of clotting?

Im not exactly sure what you mean JW77, but I get clotting of my cannulas as well. What I do is put 1ml of the diluted heparin into the 10ml flush for the cannula. If you do this you need to take that 1ml off your bolus heparin dose.

You do not state the strengdth of Heparin. I do not advice the use of Heparin while cannulating new fistulas - their walls are not matured enough and can blow up/infiltrate or leak easy… Use just normal saline. With mature fistulas you do not need to use Heparin or even normal saline as you should not spend much time cannulating, hence the possibility of clotting is minimal.

In all my years cannulating we only used “wet” sticks if we previously pulled clots from the fistula. Otherwise I like “dry” sticks because you can see the flashback better. Never used heparin in the “wet” stick b/o the fragiliity of the wall of the new or unused fistula - just normal saline “straight”. But as previously stated it depends on which way you like to stick.

Hi all,
I’ve used this technique successfully for over 10 years.

To about 8 cc of saline I had a ‘pinch’ of heparin 1-2 cc…
after using the fistula needle to remove my buttonhole scab, I flush the very diluted heparin, or at least a couple of ccs out the needle on my ‘chuck’ and draw back the balance of solution into the syrnge leaving it attached to the fistula needle line.
when I stick …the few drops of dilute salinated heparin on the needle tip discourages clotting…i still get a flash then I flush with the saline/heparin and connect.

I don’t think wet or dry has anything to do with fistula revision, blown or leaking fistula etc.

Our unit currently flushes the venous needle with heparine prior to starting dialysis. We are now in the process of changing to just flushing with saline. Does anyone else administer heparin first before starting dialysis?

I flush the arterial access with saline and 2500 cc of heparin in the venous. I have never had clots and very few alarms. I am also on 75MG of plavix which probably doesn’t hurt.