Stuart Mott, LPN, is the author of the article in NN&I’s March 2013 issue, “Considerations at initiations of cannulation.” He is a vascular access nurse from Millesburg, Mo.
Question: Do you find patients that are not good candidates for an AVF get one anyway?
Answer: Determining whether or not a patient receives an AVF is dependent upon the surgeon’s evaluation and assessment. AVFs are currently accepted as the best type of access available for patients requiring hemodialysis. We must respect the surgeon’s decision to attempt placement of an AVF, and work with them in identifying issues that arise with the AVF from the start. Communication is key between the dialysis staff and the surgeon placing the AVF.
Q: Do you think a lack of experience dealing with cannulation is a common obstacle among clinic staff?
A: Training and confidence in skills is important for successful cannulation of vascular accesses. It is important that clinic staff be allowed to practice their cannulation skills using anatomical models/manikins with feedback from staff who are considered cannulation “experts”. This allows the staff to develop their skills and confidence in a non-stressful and safe atmosphere prior to cannulating patients. Having nurses who are experienced with education principles and able to provide the support and encouragement to new staff without “rushing” them to begin cannulating is an important part of gaining the skills and experience necessary.
Q: What is a good method for keeping clinic staff up-to-date on access issues?
A: Identifying a team of cannulation “experts” in each clinic is important. In my opinion, all staff should be evaluated regarding their cannulation skills at least every 6 months to ensure that correct technique and procedure is being followed. Having a vascular access team in each unit can also work together to identify any problems with patient accesses or issues in cannulation skills that need to be addressed. New information related to vascular access care can be presented in various manners: posters, in-services, staff meetings, etc. Each unit/center will need to identify what works best for them.
Q: What is an important message you want our readers to get from your article?
A: CMS and other insurance payers are taking a close look at the costs associated with renal patients. Demonstrating that there are alternative ways to ensure success of vascular access and decreasing the costs is important. We should take the time to work collaboratively with the surgeon to ensure that the patient’s access (lifeline) is the best it can be. We can do this by ensuring that the access has matured to its potential which means not rushing cannulation; having highly trained/experienced vascular access team and cannulation staff; and providing on-going evaluation and education that implements-best practices for vascular access and cannulation.
Read more on this topic in “Considerations at initiations of cannulation.”