1. Brouwer DJ. Cannulation camp: basic needle cannulation training for dialysis staff. Dialysis & Transplantation 1995;24(11):
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1 The information provided is intended to be general guidance based on current practices in the field. 1 The steps provided here may not be complete, and are not intended to be a replacement for the education, training, and professional judgment of Healthcare Providers. Licensed Healthcare Providers remain responsible for making decisions regarding the use of medical technologies and the care of patients. 1. Brouwer DJ. Cannulation camp: basic needle cannulation training for dialysis staff. Dialysis & Transplantation 1995;24(11):
2 Hemodialysis Nurse / Technologist Didactic Main Information Bulleted Info
3 Handling Characteristics The GORE ACUSEAL Vascular Graft is designed to be cannulated immediately after implantation. It is very flexible, resists kinking and compression.
4 Tri-Layer Design Outer Graft Layer Expanded polytetrafluoroethylene (eptfe) Middle Graft Layer Elastomeric membrane Inner Graft Layer Expanded polytetrafluoroethylene (eptfe) CBAS Heparin Surface* * The CBAS Heparin Surface on the GORE ACUSEAL Vascular Graft consists of a stable, covalent, end-point attached heparin.
5 Low Bleed Barrier Low Bleed GORE ACUSEAL Vascular Graft vs Bleed Standard eptfe Graft Post cannulation of the luminal surface with a 16 gauge needle Hold pressure for minutes to achieve hemostasis post needle removal.
6 Cannulation Patients may be cannulated for hemodialysis at any time within the early post operative period. Early cannulation order form may be used as a tool for early cannulation orders to dialysis centers. For the first three sessions within two weeks of implantation, please use the suggested cannulation guidelines. Do what you normally do.
7 Early Cannulation Guidelines (For the first three sessions within two weeks of implantation)
8 Early Cannulation Guidelines Right Arm Left Arm
9 Dialysis Center Staff Training Now for the specifics of the dialysis center staff training. You have a critical role in the care of the patient needing hemodialysis. The access site is the lifeline for the patient. When performing cannulation every action you take may make the difference between success and failure.
10 Aseptic Technique: Germs are Everywhere Bacteria may be on the surfaces of glove boxes, stethoscopes, computers, adhesive tapes, and other supplies. Dialysis patients and dialysis unit personnel carry a higher-than-normal level of Staphylococcus aureus in the nose. Wearing a face mask that completely covers the nose is therefore of utmost importance
11 Aseptic Technique is Critical Teach patients to wash their access site with soap and water prior to getting in the chair Rinse the site well and dry completely Perform this ritual before every hemodialysis session Remove tape residue In the early postoperative period, incisional dressings should be protected from getting wet while washing the cannulation sites.
12 Tactile Examination Palpation Wash your hands with soap and water before touching the access site. Wear gloves if appropriate. Feel the thrill along the entire length of the graft. A continuous vibration or buzzing A discontinuous vibration that feels like a strong pulsation is a sign of stenosis.
13 Cannulation: For Aseptic Technique Dialysis staff must wear: A clean gown Face shield or mask which covers mouth and nose During the first three sessions that occur within two weeks of implantation: Sterile gloves are suggested If gloves become contaminated they should be immediately changed.
14 Preparation of Cannulation Sites Providone Iodine Solution Three to five minutes dry time Do not blot or wipe the providone iodine solution off Do what you normally do. EXSEPT Plus Solution Two minutes dry time Chlorhexadine One minute dry time Isopropyl Alcohol 70% 60 seconds at site Effective only when wet
15 Early Cannulation is at the Discretion of the Physician Guidelines should be followed for cannulation within the first two weeks post implanation Needles 17 gauge needles Blood flow ml / min Wet stick technique Ideal for first cannulations of either AVG or AVF
16 Special Reminders Hold pressure to the needle exit site Hold for minutes without looking to prevent bruising Pros and cons of clamps Do what you normally do. Not a GORE ACUSEAL Vascular Graft implantation site. Not a GORE ACUSEAL Vascular Graft implantation site.
17 Early Cannulation Guidelines Adhere to the required aseptic technique (sterile gloves, clean gowns, face masks / shields covering nose and mouth) Prevents infection Perform a swift puncture with 17 gauge needle Smaller gauge needle is less traumatic, preventing high blood flows in the early postoperative period
18 Early Cannulation Guidelines Maintain a blood flow rate of ml per minute for the entire session Low blood flow prevents damage to the vein Low dose of Heparin therapy during first week post implantation Prevents bleeding from the incisions
19 Early Cannulation Guidelines Always apply digital pressure to the needle exit sites for minutes To prevent bleeding into the subcutaneous tissue tunnel, no looking!
20 Make Early Cannulation Count Take Aways
21 Make Early Cannulation Count Steps to Prep Clean Gown Mask or Shield Sterile Gloves
22 Make Early Cannulation Count 3 Steps for Success for the first three sessions within two weeks of implantation
23 Make Early Cannulation Count 1 GO SMALL Use a 17 gauge needle to restrict flow.
24 Make Early Cannulation Count 2 WATCH FLOW Keep the flow rate at ml / min to prevent damage to the vein.
25 Make Early Cannulation Count 3 HOLD PRESSURE Hold constant pressure for minutes to achieve hemostasis.
26 Make Early Cannulation Count 3 Steps for Success for the first three sessions within two weeks of implantation GO SMALL WATCH FLOW HOLD PRESSURE
27 A Dedicated Cooperative Team ESRD patient Surgeon Nephrologist Interventionalist Nurse / technician
28 Main Information Bulleted Info W. L. Gore & Associates, Inc. Flagstaff, AZ (Asia Pacific) (Europe) (United States) (United States) goremedical.com Products listed may not be available in all markets. EXSEPT is a trademark of Alcavis HDC, LLC. GORE, ACUSEAL, PERFORMANCE THROUGH COLLABORATION, and designs are trademarks of W. L. Gore & Associates. CBAS is a trademarks of Carmeda AB, a wholly owned subsidiary of W. L. Gore & Associates, Inc W. L. Gore & Associates, Inc. AS0257-EN6 JULY 2017
29 The information provided is intended to be general guidance based on current practices in the field. 1 The steps provided here may not be complete, and are not intended to be a replacement for the education, training, and professional judgment of Healthcare Providers. Licensed Healthcare Providers remain responsible for making decisions regarding the use of medical technologies and the care of patients. 1. Brouwer DJ. Cannulation camp: basic needle cannulation training for dialysis staff. Dialysis & Transplantation 1995;24(11):
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PRIMARY IMMUNODEFICIENCIES SCIG INFUSIONS: A PRACTICAL GUIDE FOR PATIENTS SCIG INFUSIONS A PRACTICAL GUIDE FOR PATIENTS 1 PRIMARY IMMUNODEFICIENCIES ABBREVIATIONS IG IVIG PID SCIG Immunoglobulin Intravenous
UW MEDICINE PATIENT EDUCATION. What to expect and how to prepare DRAFT. What are liposuction and fat grafting? How do I prepare?
UW MEDICINE PATIENT EDUCATION Liposuction and Fat Grafting for Breast Reconstruction What to expect and how to prepare This handout explains liposuction and fat grafting when used in breast reconstruction.