Blunt AVF needle....the final part

How is it done.....?

1.   First assess the AVF and identify the directional flow of the AVF.
2.   Select the appropriate sites for the arterial (supply) and venous (return).
3.   It is pertinent to stress that cleanliness is of utmost importance in establishing a tract for and using blunt AVF needles.
4.   Clean the intended area with "Providone Iodine" or any other suitable disinfectant. Remove any scabs from previous cannulations if any. Please use aseptic technique and a pair of tweezers, NOT the tip of a      needle.
5.   Either using the 3 fingers or 2 fingers technique, secure the vessel for cannulation.
6.   Aim the tip of the sharp AVF needle for the center of the vessel at 25 - 35o and proceed with the cannulation.
7.   Once blood rushes into the syringe, level the AVF needle and glide it along the center of the vessel.
8.   Secure the AVF needle and flush it with the Normal Saline in the syringe to check for good blood flow.
9.   This procedure is repeated exactly the same, the next 8 - 10 cannulations. Same spot, same hole, same
      angle and same depth by the same cannulator.
10. During the next cannulation, soak the scab that has formed at the opening of the cannulation site with Normal Saline and slowly peel it away with a clean pair of tweezers and NOT the tip of a needle.
11. After a number of cannulation, a hole will apear underneath the scab.
12. Do not allow patient to remove the scab him/herself.
13. Thereafter cannulation through the hole will require less effort than before the site matures.
14. When the cannulator is satisfied the tract has been formed and is matured, can he/she starts to use the
blunt AVF needle for cannulation.
15. When he or she is confident that other treatment practitioner can cannulate successfully the buttonhole with a blunt AVF needle can then others cannulate the patient.


What's next.....?

1. Do not use a sharp AVF needle on a mature site as it can injure the tract.
2. Do not use too much force when cannulating with a blunt AVF needle.
3. If bleeding occurs around the blunt AVF needle, it means that the tract is stretched or scarring has occurred.
4. If you are unable to insert the blunt AVF needle into the vessel, push the vessel to the vessel and gently lift the tip of the needle.The flap of the vessel may be misaligned with the tract.
5. If this does not work, then use a sharp AVF needle for the next couple of cannulations. Ensure that you stay in the tract so as not to injure or scar the tract. This will help in refashion the flap of the vessel.
6. What if the tract does not take form, not to worry. Select a new site and create a new tract.

Obstructions to a successful creation of a tract.....

1. Badly scarred vessel due to cannulation problems.
2. Thick subcutaneous layer.
3. One too many cannulators on the same patient.
4. Stenosis present at the chosen site.

Benefits.....

1.   Patients enjoy less painful cannulations.
2.   Patients can self cannulate.
3.   Patients experience less stress during cannulations.
4.   Less cannulation complications.
5.   Less mistreatment or reschedule treatments.
6.   Fewer hospitalizations due to cannulations or AVF complications.
7.   Longer AVF survival.

8.   Faster cannulations.
9.   Less stress on treatment practioners due to problematic cannulations.
10. Increased safety with less stick injuries.

The cost of a blunt AVF needle....?

Presently the cost is higher than a sharp AVF needle but nevertheless it is worthwhile to consider it and prices will comedown when demand for it increases.......

Are you game for it......talk to your patients.......explore the posibilities.....