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Using 'tandem hand' technique to facilitate self-cannulation in hemodialysis.

Article Excerpt
It is well established that self-cannulation extends the life expectancy of the native arteriovenous fistula (AVF) (Hakim & Himmelfarb, 1998; Huber, Carter, Carter, & Seeger, 2003; Mehta 1991; Perera et al., 2004; Pisoni et al., 2002), is associated with fewer complications (Hakim & Himmelfarb, 1998; Huber et al., 2003; Mehta, 1991; National Kidney Foundation [NKF], 2006; Perera et at., 2004; Verhallen, Kooistra, & van Jaarsveld, 2007), and the process is more comfortable for the patient (Ball, 2006; DaVita, 2007; Verhallen et at., 2007). The use of the buttonhole technique was first reported some 30 years ago (Twardowski & Kubara, 1979; Twardowski, Lebek, & Kubara, 1977), but it has not been significantly utilized in the U.S. The buttonhole technique is particularly attractive for self-cannulation and has been recommended in the NKF's Kidney Disease Quality Initiative (KDOQI) guidelines (2006) as the method of choice for self-cannulators. This article discusses a method found by the authors as successful in teaching patients to self-cannulate.

The Tandem Hand Technique

Phase 1

The patient who is interested in learning to self-cannulate needs to be assigned to a vascular access nurse preceptor who will supply information relative to self-cannulation and discuss with the patient the benefits and possible problems relative to the process of self-cannulation.

For the new patient, access evaluation and preparation of the access site must be covered prior to discussion of cannulation. In the established patient, a review of this material is necessary to make certain that an understanding of all basic fundamentals exist at a level that will ensure success. Patients will most likely be initially apprehensive and uncomfortable. Many will be apprehensive regarding needles and/or the sight of blood. Most will be apprehensive because it is a new experience and they fear making a mistake, which could cause an access problem. Others will have a "fear" of the needle, and a small percentage will have a true phobia.

Educational materials and methods must be developed by the preceptor to help the prospective self-cannulator overcome these fears. One example might be having the patient watch others being cannulated, and then have the patient watch himself or herself being cannulated. Another option would be that if there is a fear of needles and/or blood, to start by having the patient just glance at himself or herself, or to glance at another patient being cannulated seated close by, each time trying to extend the time watching until the patient becomes comfortable with the sight of his or her own or another person's blood.

If a patient has a fear of all types of needles, instruct the patient on how to hold the needle correctly. After this is accomplished, provide the patient with a blunt buttonhole (Medisystems ButtonHole[TM]) needle set, giving him or her the opportunity to handle the needle in the proper manner...

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