Hello everyone 
I have recently been hired on with a company in MN as a Pt care tech.
I have a medical background from the military and some college courses
under my belt. I am excited about my new career path but am a little nervous too being as I haven’t been exposed to this line of work. I have already begun researching online and trying to learn some things on my own. I will be training for 6 weeks prior to going to my actual work-site and doing my job. I was wondering if someone can explain what an AV
Fistula is? Is this like a bovine graft in the forearm? Is this a common site
for infusion in most of the renal pts that I’ll come in contact with? I’m sorry if my questions seem stupid :oops: I am going to be trained but am trying to learn a little before I get started at my job at the end of May. Thank you
for reading
Congratulations on your new job and on your interest in learning more about dialysis. There are three types of vascular access for hemodialysis: fistula (1st choice – uses the patient’s own tissue to connect an artery and a vein), graft (2nd choice – uses artificial tubing to connect the artery and the vein), and catheter (last choice, usually temporary or for patients that cannot have one of the others). The federal government through the Centers for Medicare and Medicaid Services has launched an initiative called Fistula First to promote use of fistulas in dialysis because patients with fistulas have a significantly lower risk of infection, hospitalization, and are less likely to die from these complications than those with other types of hemodialysis access.
You might want to review the modules on Kidney School (www.kidneyschool.org). There is a module (Module 8) that is devoted entirely to vascular access. Other modules include general information about kidney disease, options for treatment, reading and understanding lab tests, coping, sexuality, nutrition, etc.
You can find links to more information about vascular access on this site at (www.homedialysis.org/v1/links/#6).
There are two national organizations for technicians. One is the Council of Nephrology Nurses and Technicians (www.kidney.org/professionals/CNNT/index.cfm) which is a professional council of the National Kidney Foundation. The other is the National Association of Nephrology Technicians/Technologists (www.dialysistech.org). These organizations have helpful tools for technicians.
Good luck with your new job!
Beth, Thank you so much for all the info. It has really helped alot
Susan
No question when it comes to patient care is stupid. An AV Fistula is actually a native vien and artery that have been disected laterally and then sewn together. You will see alot of these because this is what DOQI guidlines are pushing for. Native vessels won’t be rejected by the body and therefore has less chance for infection. However these tend to be very delicate in the begining and care must be used during cannulation because infiltration in very easy!! Hope this helped!!!
To reduce the chance of problems with fistulas:
– Encourage patients to get fistulas early enough so they can fully mature before being cannulated (stuck) the first time.
– Make sure that the first few times any fistula is cannulated the most experienced nurse or technician at the clinic does it.
– Use the buttonhole technique rather than the “ladder” technique to cannulate their fistulas. The ladder technique can cause more problems with a new fistula.
– Have nurses and technicians teach all patients with fistulas who are willing and able to learn to do their own sticks, including how to start and use buttonholes. Although this takes time at first, it will save time later on.
– Encourage patients to cannulate their own fistulas every dialysis session, provide mentors who cannulate their own fistulas, and provide lots of praise. Having one cannulator saves accesses.
See Dr. Twardowski’s PowerPoint slides and other resources on the buttonhole technique under Professional Resources from the Home Dialysis Central home page.
Beth,
Yours is accurate advice and should be the norm in units thus empowering patients. Why do you think most units have been so slow to realize this and have done just the opposite?
I think old habits die slowly. I’m not the first person to make some of these suggestions. I’d be really interested to hear from nurses and technicians on this one.
In my experience, I have talked with staff you have never heard of or seen a patient do his/her own sticks. Because they have this attitude, they assume patients would never want to do it and they they don’t ask patients in a way that encourages this. I think they feel like staff are more competent to do needle sticks and they think patients will damage their accesses and that they’ll be liable if that happens. So far as the ladder vs. buttonhole, I’d be willing to bet that most staff have never heard of or know how to create a buttonhole or use the buttonhole technique of cannulation.
Some clinics do have expert cannulators who stick new vascular accesses. Some clinics are starting to do buttonholes. Some clinics encourage patients to do their own sticks. All we need to do it have those people share their positive experiences with the non-believers.
I agree with what Beth said, and also believe that dialysis providers have gotten into the habit of seeing themselves as active-carers and dialyzors as passive recipients of care–an attitude that interferes with even thinking about empowering them to do more. Of course, this also doesn’t give dialyzors any credit for all the self-management they do in the 92% of the time that they’re not in the dialysis center! (This self-management includes making food choices, following a fluid limit, taking medications correctly, noticing and reporting symptoms, and coming for treatments).
One of the reasons we built this site is because we want to change the paradigm of care in this field, which was built on an acute care, medical model that is not a good fit for a chronic disease like kidney failure. Home dialysis is at the upper end of the self-management continuum. Dialyzors are purposefully educated to do their own treatments and to troubleshoot. This entirely changes the dynamic and empowers both the dialyzor and the staff person (it’s much more rewarding to work with active, engaged people than passive, depressed ones). So, it’s a win-win.
hi i found pt care job
A heartiest congratulation for new jobs now you are going to set a new path for your career .You can get help online to learn more. Many physicians share their research online.