What things should be looked at when having trouble cannulating the AV Fistula?

Ask Our Experts Stuart Mott, Cannulation Expert
1

I have been seeing a lot of people (on other kidney forums) ask this so I kept telling them to come here and ask if they haven’t gotten any answers from their medical team. But I don’t see a thread on this so I will start this.

What things should be looked at when having trouble cannulating the AV Fistula?

Not everyone who has this question self-cannulates and even though I know this is a home hemo dialysis forum, I wanted to mention that some want to go that route but are having their fistula’s established in cente.

I myself had problems with mine because mine was “wobbly” and it was hard to get the same path every time when attempting to establish buttonholes. But this is a generalized question in hopes to help others who have asked this question on KidneySpace and KidneyKorner.

Hope you can help answer this Stuart. :slight_smile:

2

The question you ask is one that is brought up in many of my public speaking engagements. First, let me ask about your access:

  1. Do you have someone there to help you cannulate?
  2. Do you use a tourniquet?
  3. Do you use 3/5 inch cannulation needles?
  4. How do you remove your scabs?
3

When blunt force is applied to your access by a buttonhole needle, the vessel will MOVE. This can make it very difficult to cannulate. Fistula First Guidelines say a tourniquet should be used in all arteriovenous fistulas (AVFs). This is the first place to start. Using a tourniquet helps hold the vessel in place, so you can cannulate your Buttonhole.

If someone else is on hand to help you, there is a second step you can take. A helper can wrap his or her hand around your arm, with the thumb ½ inch behind the Buttonhole site, and pull back on your AVF. This holds the vessel steady so it is less likely to move when the needle is placed. I use this method and teach it.

4

Did the info that I gave you help with your “wobbly” access?

5

[QUOTE=Stuart Mott;19564]When blunt force is applied to your access by a buttonhole needle, the vessel will MOVE. This can make it very difficult to cannulate. Fistula First Guidelines say a tourniquet should be used in all arteriovenous fistulas (AVFs). This is the first place to start. Using a tourniquet helps hold the vessel in place, so you can cannulate your Buttonhole.

If someone else is on hand to help you, there is a second step you can take. A helper can wrap his or her hand around your arm, with the thumb ½ inch behind the Buttonhole site, and pull back on your AVF. This holds the vessel steady so it is less likely to move when the needle is placed. I use this method and teach it.[/QUOTE]

I have to agree with Stuart on the tourniquet recommendation. I have been using one since starting NxStage and using buttonholes. The tourniquet really pops up the vein and holds it in place. As long as you are in the same position when cannulating, the needles go right in unless there is an issue with my fistula.

///MM

6

Thanks for your input.