I was viewing a MediSystems video on cannulation and the patient who was self-sticking was not wearing gloves. In your programs did they train you to wash hands and wear gloves before cannulating?
We wash hands but do not need gloves, no need to protect ourselves from our own blood. I not only wash hands and fistula, but use betadyne, alcohol and hand sanitizer prior to sticking. Gloves are not sterile and are mainly to protect the sticker. Just as they wear masks but we don’t have to.
Cathy
For patients self sticking gloves are suggested but not required. However, you must be very careful not to contaminate the tip or edges of the needles…and if you do you’d need to use a new needle. Other than that, washing your hands and using hand sanitizing lotion is something you should do always…
In my case. maneuvering the needle with gloves is difficult espcially with the carpal-tunnel in my hands …
I don’t wear gloves either. It was never part of the program. Nurses wear them primarily so you don’t contaminate them with your blood, not the other way around, as Cathy said. At home, you are the only one who can contaminate yourself, and proper, careful procedure should prevent that. Gloves aren’t sterile items anyway, even straight out of the box.
Pierre
Can anyone provide an article proving that gloves are only for the benefit of the nurse/tech, not the patient? I would like to know that this is not just an opinion/myth that has been passed around. My reading of the CDC and DOQI guidelines gives me a different impression.
If you want to wear gloves, wear gloves, who cares. Just look at the box of gloves, it says right on there NOT STERILE, so what is the benefit.
Cathy
I care about a safe tx, Cathy. Gloves are not sterile, but the CDC and DOQI say that the proper use of gloves and the other steps they have listed cut down on the possiblity of an infection. There are a lot of myths in dialysis and I like to know where people get their information. I feel there should be standards on which to base tx protocols. I do not blindly trust anyone’s info. I want the proven rationale-never the opinion/myth.
When you are doing it all yourself at home (not a helper, but yourself), it would really be a hassle to manipulate things you have to handle with gloves on. I mean, you’re doing many things with just one hand that they do with both hands at the dialysis centre. You’re not supposed to touch anything that will go in you, or that will contaminate the blood circuit anyway. You would still have to do that even with gloves, so what’s the point? At a dialysis centre, there are plenty of dangerous bacteria and viruses around, but in your home, the only germs there are your own. You are your own patient and your own nurse. You’re not working with a bunch of different patients with plenty of chances to spread blood prints around. It’s a totally different situation.
There’s no law against wearing gloves, but personally, I think there would be greater chance of contaminating yourself with them, just because you might be more prone to dropping or mishandling things.
Have I ever seen a study? No. I’ve never seen a study about how to do my dialysis treatments either. I just go by my training, and that itself is based on a lot of accumulated experience not just at my dialysis unit but at all of them combined.
Pierre
Then do a google search rather than arguing here, or wear gloves. We are comfortable with our method. FWIW I had a conversation about infections last visit at my clinic and they have a 100% no infection rate with all their at home patients and we do not use gloves (although they always do in center when touching me during any treatments or when giving me any kind of injection (where they also always wear masks to protect them from my blood)). You also might note that although we are all at different centers we are all (so far) in agreement about the necessity of gloves if doing your own cannulation and use other sanitary methods, including washing and disinfecting (as said earlier I not only wash with anti-bacterial soap, I use betadyne and alcohol AND hand sanitizer.
Cathy
Hi y’all,
Interestingly, even though it is very important, vascular access cannulation is one of those topics that gets very little research attention, so I don’t know that there are studies on whether folks who put in their own needles should wear gloves or not.
So, I did what I often do when I figure the literature won’t help me–I asked some experts, nurses who all work on the Fistula First project. I won’t name names, because I didn’t ask if I could quote them, but the consensus was, even at home, and even though it’s inconvenient, it’s a good idea to wear gloves, because you touch other surfaces (e.g., the touch screen on the machine, etc.) and because other family members could be exposed to your blood w/o gloves.
I don’t have the answer on the “best” way gloves or not. I have always wondered why I scrub for 3 minutes and then put on gloves. The only thing I can figure is that although the gloves aren’t sterile (unless you buy sterile) is because they are clean and probably don’t have bacteria on them. And you can change them after touching syringes, the machine or whatever. Where as there is a limit as to just how many times you can wash and clean your hands.
When you are doing it yourself, you’re not directly touching anything that’s of any consequence. The only time in the whole procedure when you are is when you are folding 2x2’s to hold your site after removing needles. If you contaminate the gauze, you could potentially infect the site itself. So you fold without touching the surface that will go against the skin (and use betadine ointment on the gauze if that’s part of the program).
You don’t touch the actual needles, and you don’t touch any of the mating surfaces of connections. You hold tube ends, etc. using the cigarette method while you manipulate them, so that you minimize any chance of accidentally touching anything.
There’s a lot more risk of putting bacteria on needles, open connectors, etc. just by breathing or suddenly coughing on them. So, are you going to wear a mask too?
If you follow a logical procedure, you only wash your hands once unless you decide to pick your nose or something, and then you do all the sensitive connections, etc. Then you wash hands again just before putting the needles in - but it’s really just a precaution. The whole thing can be done washing hands only twice.
Pierre
Hi y’all,
I was kind of in a hurry when I posted before, so I didn’t get a chance to include the specific points my panel of nurse experts mentioned. Here they are:
• Gloves may be a better bet for self-cannulation in-center, even if you don’t use them at home.
• W/o gloves during needle insertion and removal, blood could possibly get onto other surfaces, like the machine screen, where other folks in the home could come encounter it.
• It might make sense to wear gloves while connecting with a catheter, even if you wouldn’t use them with a fistula or graft.
• it’s safer to err on the side of caution/safety when dealing with the
possibility of infection. The access is an open line to the bloodstream, and requires meticulous care.
Which brands of anti-bacterial soap are recommended? We find some brands too harsh. What other products besides alcohol and betadine are used in programs?
Also, what are good products to put on the access inbetween txs to keep skin from becoming dry and cracked?
The skin around my needle sites has a tendency to dry out. It gets a lot of use, what with betadine, tape, etc. I’ve used just ordinary skin cream for years. I just buy standard brands, mostly Vaseline, but the unscented ones.
On the gloves issue, when you work with the needles, you hold them by the wings, and you pull the cover off. Then you guide it into the buttonhole still holding it by the wings or the tube. Gloves or no gloves, you never touch the needle or the needle site. If you did accidentally touch it, it would have to be considered contaminated even if you were wearing gloves. There’s just no point to them at all, unless you are a helper rather than the patient.
Pierre
Pierre, Do you mask when you set up so as not to breath on connection ends or sneeze or something? Is there any advantage to washing with hibilcens as compared to just antibacterial soap or regular soap?
A nursing student from our facility told us that his professor said that hand sanitizer is ineffective-only soap and water cleansing well really cleans.
Nope. I have masks but only use one when injecting peroxide into my R/O. I’m very careful though with my sterile technique (Touch wood!). I find it’s kind of like driving the car myself rather than being a passenger. I feel safer when I’m driving. Similarly, when I put myself on, I control every aspect of it. So I can be more careful than I would expect a nurse to be. I don’t want to sound like I’m reckless though. Even though nobody can see me, I still hold everything exactly as I was taught. I also avoid coughing on things. Breathing I don’t worry about too much though. It’s my own breath and my own germs. It’s also my own blood, so I can’t give myself hepatitis or HIV. After I take myself off, first thing I do is to wash my hands before I touch anything else, just to prevent someone else in the house coming into contact with blood on door handles and what not. As far as the dialysis machine goes, nobody touches it except me.
I’m not discouraging anyone from using gloves or masks. I’m just saying that there is legitimate disagreement about the necessity of this for home patients. I only do what I was taught, and gloves weren’t part of it, except for when disinfecting the R/O.
I just use ordinary hand soap for my hands. I think studies have shown this is as effective as more elaborate products.
Pierre
After washing, using betadyne and alcohol you do not touch anything but the needle and tape. You are to wipe down the machine and everything else with a bleach solution every night which will take care of touching anything with a bit of blood on your hands.
Nurses in center often touch the fistula or site but I never do, I use tweezers kept in alcohol to remove the scab and only touch the wings of the needle. When inserting the needle I never come close to touching the site. So, sorry to disagree with your Fistula First nurses, but I honestly cannot see any purpose to the gloves. If they touch the screen they become contaminated, it they touch anything else they become contaminated, just as our hands would be. If a gauze is contaminated after dialysis, using a glove will not protect against that.
With regard to antibacterial soap, hand sanitizer etc., I choose to err on the side of caution, using every one of these gives me the most protection. If you look in doctor’s offices and hospitals, they use both hand sanitizer and anti-bacterial soap. I do not use anti-bacterial soap for anything other than dialysis as studies say over use of it may lead to more antibiotic resistant bacteria, but when dealing with direct access to my blood I want as little bacteria as possible around it so I take all possible precautions (and feel not using gloves is actually better, as I don’t think the gloves are as clean as my hands.
With regard to masks, my nurses don’t wear mouth masks they wear the clear face guards, they are again protecting themselves from my blood, not me from them.
Cathy