Fistual Access Site Prepartion

I was in-center for 3 years and have done NxStage Home Hemo for over 2 years. I have traveled some with visits to 5 different locations. It appears no one uses the same techniquie for preparing access sites.

Some use alcohol swabs, others ExEept, Betadine and in no particular order. It seems it has changed over the years, using less supplies, ie. syringes, tape, bandaids, betadine.

I started out the way I was trained; I wonder if they are changing to reduce cost instead of making sure the patient the most sterile access.

Any responses would be appreciated.

Charles

Hi Charles

Seems this is a problem anywhere in the world. I have dialysed in 7 centers here in Australia and am always amazed at the differences in techniques and supplies. In many cases it comes down to the dollar and what is the cheapest. I am sure I speak for all home dialyzors and self cannulators when I say that you have your routines and setups that you follow and it can be quite unnerving to go in center and find a different system or supplies and even within the one center nurses doing different techniques. You really have to focus on what you know is best for you.

When i get a chance to travel I now take my own bottle of Betadine and all my own dressing packs and of course , cannulas and dialysers so that I feel comfortable and familiar enough in my little corner of a ward that I don’t have to stress out and ask for things.

Cheers

Dialysis facilities have policies and procedures for what disinfectant(s) are used for access care. They should take into consideration how the particular disinfectant affects the skin. Patients should wash his/her access site prior to either of these to assure that they have cleaned the site as well as they can. Some facilities use alcohol alone. Others use betadine alone. Still others remove the betadine with alcohol. Some facilities may not use betadine because it has a shorter shelf life than alcohol.

BTW, if a patient’s skin is becoming too dry or looks like it’s getting inflammed, the patient should report this because the skin is the last line of defense against germs. When disinfecting the access site prior to cannulation, rub the disinfectant on the skin in a circular motion (rather than rubbing back and forth) starting at the center and rotating way from the center to the outside.

So far as disposable supplies are concerned, dialysis facilities provide the supplies a Method I patient needs to perform dialysis. Medicare pays a bundled rate (called the composite rate) that is intended to cover these patients’ equipment and supplies as well as labor costs for a nurse, dietitian and social worker available to patients as needed. Not meaning to make excuses, but like any other business, dialysis facilities negotiate contracts to get the best supplies they can get for the lowest cost.

Quote
(BTW, if a patient’s skin is becoming too dry or looks like it’s getting inflammed, the patient should report this because the skin is the last line of defense against germs. When disinfecting the access site prior to cannulation, rub the disinfectant on the skin in a circular motion (rather than rubbing back and forth) starting at the center and rotating way from the center to the outside.)

Thanks Beth
That’s news to me!
Cheers

[QUOTE=cehill;16646]I was in-center for 3 years and have done NxStage Home Hemo for over 2 years. I have traveled some with visits to 5 different locations. It appears no one uses the same techniquie for preparing access sites.

Some use alcohol swabs, others ExEept, Betadine and in no particular order. It seems it has changed over the years, using less supplies, ie. syringes, tape, bandaids, betadine.

I started out the way I was trained; I wonder if they are changing to reduce cost instead of making sure the patient the most sterile access.

Any responses would be appreciated.

Charles[/QUOTE]
Additional Fistual Prep Info: Process for cannulation

  1. Wash hands and fistula site with anitbiotic soap (I have been using the foaming type lately); then dry with paper towels.
  2. Prior to removing scabs from buttonhole sites I use Except to disinfect. Use plastic throw-away twezers to remove scabs.
    3 Prior to cannulation I clean the site area with alcohol swab making sure to remove scab material and to wet the site area with suffiient alcohol.
  3. Upon cannulation with the blunt needle I then place a band-aid accross the wings of the needle. Then paper tape of short length up and down accross the blue tips. Then a longer piece of tape accross the blue tips; then the typical tie down that every center seems to use.
  4. I then loop the lines and secure with tape and then loop down length of arm with tape to secure (I notice in most recent center they only tape at site entry and use blue scissors to attach to shirt sleeve)
  5. I then flush the arterial needle with 10cc of saline; I give the prescribed amount of herapin in the venous needle followed by a flush of 10cc of saline
  6. Hook up and proceed with treatment.
    8 At termination of tx I flush each needle with 10cc of saline.

Note: This was close to how I was trained with the exception of using betadine. Now most centers are not flushing at all before or after. I was using betadine followed by a small amount of alcohol just prior to inserting needle at site. My Nurse has suggested that I use ExSept which is a clear solution instead of Betadine.

I would like responses to these procedures from you Home Hemo folks; I like improving my process however I do not like the idea of changing just to save money if it may impact my health. I understand
Big Business as I worked for them for 30 years.

Thanks…

Charles