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What Nephrologists Need to Know about Vascular Access Cannulation
Author(s) -
Dinwiddie Lesley C.,
Ball Lynda,
Brouwer Deborah,
DossMcQuitty Sheila,
Holland Janet
Publication year - 2013
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/sdi.12069
Subject(s) - medicine , nephrology , vascular access , intensive care medicine , quality management , adverse effect , emergency medicine , medical emergency , hemodialysis , management system , management , economics
This article describes cannulation events, especially problems, common and rare, minor and major, to aid the nephrologist (and mid‐level providers e.g. nurse practitioner and physician’s assistant) in decision‐making to prevent or treat cannulation‐related adverse outcomes. The usual management, potential outcomes, nephrologist intervention, and prevention are discussed and include: assessment of arteriovenous (AV) access and readiness for cannulation; initial cannulation of both arteriovenous fistulas and grafts; needle size and adequacy; needle direction and potential for recirculation; limited cannulation sites/buttonhole; pain and fear of pain; prevention of bleeding; management of infiltrations/extravasations; prevention and management of “one‐site‐itis”; prevention and management of infection. It concludes with the importance of the medical director as the leader of the continuous quality improvement (CQI) team in preventing/reducing cannulation‐related adverse events.