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Cannulation of upper arm fistulas: limb position is everything.

Article Excerpt
Q: Is there anything I can do to be more successful cannulating an upper arm fistula that rolls or retracts into the tissue upon attempted cannulation? Even stretching the skin does not help much.

A: Vascular access is a hemodialysis patient's lifeline, and successful cannulation is critical to the viability of the vascular access. One of the best ways to preserve the access is to try to make every cannulation trouble-free by decreasing cannulation attempts and needle manipulation. This will lessen the chance of infiltration and damage to the intimal lining of the vessel wall of the vascular access.

Problems with cannulation of upper arm accesses are common, particularly in obese patients. Because immobilization of vessels is a problem, cannulation can require multiple attempts to achieve a viable access. Cannulation can be troublesome due to a variety of reasons, including the blood vessel rolling or retracting into the surrounding tissue (Ball, 2005). Multiple needle sticks increase the probability of vessel damage due to the development of aneurisms, infiltrations, and vessel lining damage. The number of possible access sites is limited, so it is crucial to use strategies that prolong the viability of the vascular access.

Limb Position Is Important

The staff...

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