I want to explain what happens during the self cannulation process and the terminology. And some end of treatment terminology. So by now you know cannulation is the fancy terminology for sticking myself with a needle. Before I stick myself I have to practice good asceptic technique. Asceptic technique is basically making sure the stick site is clean, clean, clean. Reduce the chance of contamination and infection as much as possible. I got a little of this at my original dialysis center. I was never really told or instructed to clean my access site. Or at least it wasn't consistent. Some techs and nurses insisted on cleaning the access, some never mentioned it. I learned from watching other really diligent patients cleaning their accesses.
Now cleaning the access is a multistep process. In all centers I've visited, there are sinks where we can wash the access with antibacterial soap. I start off washing my hands thoroughly. Then I rinse the soap off. Once the soap is rinsed off my hands, I put water on the access site on my upper left arm. One of the reasons I do this is to start the process of loosening up the scabs. Yes..scabs form on the bleeding sites. After soaking the site for a amounted, I lather up again and wash the acces site for about a minute. I rinse then pat dry. After this, I get the alcohol pads and place the pads on the scabs. Again this is to further loosen up the scabs. At my old center I was encourage to use the alcohol pads on the scabs until the tech was ready to cannulate me. Soaking the scabs.
I usually do this as Brian is preparing the machine. Once he's finished and has entered in the data, it's time for the next step. We use Purel, provided by the dialysis center (!) and the out on out medical gloves. I wipe each access with a betadine pad. I go in a circular motion over the accesses , the buttonholes, for a total of 30 rotations moving out slightly from the actual button holes. This is to make sure the area around the buttonholes are clean also. The needles have these little tools to remove scabs, so I start the process of removing the scabs. The techs and nurses always thought this was much more painful than the stick. It doesn't hurt me .. Maybe I have a low tolerance for pain... but it can be time consuming. It's very important that I remove the scabs. I don't want them to get them in the bloodstream. It can cause infection. The scab removal can really take time.. This is why I try my best to loosen the scabs up prior to the process. Anyway. Now it's time to stick!
The needles come in a packaged set of 2 and they are color coded. Well, the clamps on the needles are color coded. One is green, one is yellow. The green is for the arterial access, the yellow is for the venous access. I start with the arterial, this the access that is lowest on my arm. The needle is actually a needle with tubing attached. My buttonholes are where I insert the needles. Think of buttonholes as the holes in your pierced ears. I am not doing random sticks. I am inserting the needles in established tracks in my arm. Now just to be sure I am inserting in the right direction, the fistula buzzes and I can feel the buzz where the vein is, so I insert the needle in the direction of the buzz. The needle usually just slides in. Even now, I'm surprised at the ease the needle goes in.
I know the needle has struck gold when I see a "flashback" of blood in the tubing. Not a lot of blood. The amount of blood that flashes back is actually very small. It's just enough to know that I've correctly cannulated myself. And yes, there have been times when for whatever reason I've misplaced the needle. No pain, but I have to adjust the needle. And no, that's not painful either. After the flashback, Brian does the elaborate taping ritual. And I repeat the process with the venous needle.
Once the needles are in and I've been taped up, he primes the tubing. Primes? Yes. He opens the clamps, which allows the blood to flow through the tubes. He also opens a little cap on the end of the tube. This allows the blood to flow through the tube. When the blood fills the tube he closes the cap. We test the ease of flow of the blood through the tubes. The blood should move fast and freely. If not, we have a problem..usually with the stick and I need to adjust the needle.
Wow that's a lot and I'm not even attached to the machine yet. Well I'm stopping here and I'll just have to finish this up on Wednesday. So this week, every class is on spring break..go figure. And I know I'm in Vegas because this weekend I could go skiing and then go to the waterpark. No I didn't do either. But I could have!!
Photos of gloves, needle with scab removal tool and my two needles.
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