Change Concept 8
Cannulation training for AV fistulas
- Facility uses best cannulators and best teaching tools (e.g., videos) to teach AVF cannulation to all appropriate dialysis staff.
- Dialysis staff use specific protocols for initial dialysis treatments with new AVFs and assign the most skilled staff to such patients.
- Facility offers option of self-cannulation to patients who are interested and able.
Prevent fistulae from being destroyed by inexperienced staff. Discuss the basics of needle cannulation with all staff.
Changes for Improvement:
Use Experienced Staff and Teaching Tools to Train All Appropriate Dialysis Staff on AVF Cannulation
Identify the experienced cannulators on your staff; make sure they are available to cannulate all new fistulae and to train inexperienced staff. Identify and make available to your staff appropriate teaching tools.
Use Protocols for Initial Dialysis Treatments with New AVF Patients
Dialysis staff should develop and use a specific protocol for initial dialysis treatments with new AV fistula patients and assign the most skilled staff to such patients.
Teach Self-Cannulation to Patients Who Are Interested and Able
Facilities should offer the option of self-cannulation to patients who are interested and able.
Related Tools
A video series to educate dialysis facility staff on successfully cannulating AV fistulas.
A sample policy and procedure statement on successfully cannulating new arteriovenous fistulae and preventing infiltration.
Revised 09/09
A sample policy and procedure statement on when and how to use clamps in dialysis settings.
An example procedure statement on successful self-cannulation of vascular access.
A checklist for patients who will be self-cannulating
Revised 09/09
This technique has been identified as a Best Practice for teaching patients to self-cannulate. Reprint permission has been granted by ANNA's Nephrology Nursing Journal.
Article by Lynda K. Ball cites evidence-based, best demonstrated practices to utilize in improving individual cannulation techniques. Reprint permission has been granted by ANNA's Nephrology Nursing Journal.
A tool for determining and developing the cannulation competency of dialysis staff
Revised 09/09
An interactive module designed for training both patients and staff regarding the benefits and care of AV fistulae, how to encourage AV fistulae as a primary access, and how to conduct cannulation training.
Buttonhole Tools
Provided by Mid-Atlantic Renal Coalition, ESRD Network 5
Midlothian, Virginia
USA
Presented by Lynda Ball, MSN, RN, CNN
PowerPoint Handouts
Patients with AVF buttonhole sites who have interventions, are hospitalized, or travel have increased risk of damage to their sites. Make sure your buttonhole patients carry a Buttonhole Patient ID Card to inform professionals not familiar with the technique how to access their AV fistulas. This faxback form is for facilities to request free ID cards for their current buttonhole patients, and not intended for individual patient requests.
These techniques have been identified as Best Practices for cannulating buttonhole sites, as well as cannulating any difficult upper arm cannulation sites. Reprint permission has been granted by ANNA's Nephrology Nursing Journal.
This technique has been identified as a Best Practice for cannulating buttonhole sites. Reprint permission has been granted by ANNA's Nephrology Nursing Journal.
This historical paper describes the orgin of the buttonhole method, early results, and the reasons why the method has not gained widespread popularity in U.S. hemodialysis centers.
Article by Lynda Ball, provides an evidence-based educational tool for nephrology nurses to enable them to perform and troubleshoot the buttonhole cannulation technique for accessing an AV fistula. Reprint permission has been granted by ANNA's Nephrology Nursing Journal.
Reprint permission has been granted by ANNA's Nephrology Nursing Journal.
Buttonhole Damage from Sharp Needles
Powerpoint presentation / Handout
A handy one page guide to the Buttonhole Technique including tips on scab removal and useful references for further research.
Revised 09/09