AVF CANNULATOIN

Equipments:

1. Venous needle
2. Arterial needle
3. Tourniquet
4. Alcoholized Cotton ball
5. Plaster/tape
6. 1 pc 10cc syringe
7. Waste receptacle
8. Personal Protective Equipments (mask , gown and clean gloves)

Procedure:

1. Secure the patient’s consent

2. Wash hand and put on PPE (mask , gown and clean gloves)
3. Place patient on a comfortable position and expose her AVF access for assessment
4. ASSESSMENT - assess AVF access prior to every cannulation
a. Inspect patient’s dialysis access for any infection (redness, drainage and abscess),
central or outflow vein stenosis (edema, small blue or purple veins) and steal syndrome
(fingers are discolored)
b. Palpate patient’s dialysis access for temperature ( warmth=infection and cold= decrease
blood supply), thrill (normally a thrill is present at the anastomosis, and disappears
when you manually occlude the AVF; thrill can be felt at the site of a stenosis) and vein
diameter (feel the entire length of the AVF, evaluate for needle site selection and
evaluate if new AVF is ready to cannulate)
c. Ask the patient if there is any changes, pain and numbness about their access and
auscultate for bruit ( normal bruit= continuous, soft, low pitched and swishing sound)
5. IDENTIFY IDEAL SEGMENT OF AVF
a. Look and feel for a straight segment of AVF
b. Segment must be as long as the needle length (i.e., 1” minimum)
c. Stay at least 1.5” from the AVF anastomosis
d. The arterial and venous needles need to be 1” to 1.5” apart
e. Avoid curves, flat spots, and aneurysms to prevent complication
6. SKIN PREPARATION – proper needle-site preparation reduces infection rates
 Locate, inspect and palpate the needle cannulation sites prior to skin preparation.
Repeat prep if the skin is touched by the patient or staff once the prep has been applied,
but the cannulation not completed.
 Cleanse the skin by applying the alcoholized cotton ball (saturated in 70% isopropyl
alcohol) in a circular, outward motion.
  Allow the area to dry for 30 seconds to allow antimicrobial activity on the skin.
7. ANESTHETHIC OPTIONS FOR PAIN CONTROL- are utilized to make the cannulation procedure
less stressful for patients
a. Intradermal Anesthetic (Lidocaine) - Inject 0.1 cc of lidocaine under the skin of the
insertion site and be sure that the needle doesn’t enter the skin at a degree angle > 15.
b. Topical Sprays (Ethyl Chloride) – Spray the AV site, prep skin then insert needle
immediately
c. Topical Creams (Emla Cream) – Apply the cream on the insertion site at least 1 hour
prior to needle insertion
8. TOURNIQUET USE – The proper use of tourniquet is required for all AVF cannulation this
includes large AV fistula that appear dilated without tourniquet. Tourniquet allows uniform
dilation of the vessel prior to needle insertion.
 Apply tightly enough to engorge vessel, but not too tight that it occludes arterial flow.
9. NEEDLE INSERTION
a. Stabilize, but not obliterate the vessel.
b. Pull the skin taut in opposite direction of needle insertion to allow easier needle
insertion. It compresses the nerve endings, blocking pain sensation to the brain for
approximately 20 seconds.
c. Look for straight areas of at least 1” in length
d. Avoid aneurysms and flat spots
e. Stay 1.5-2.0” away from the anastomosis
f. Use approximately 25° angle of insertion with bevel up or depending on the depth of
the access angle. Arterial needle placement can be in antegrade (up or in the direction
of the blood flow) or retrograde (down or against the direction of the blood flow). The
venous needle should always be in the same direction as the blood flow.
g. Once you enter the fistula and see the flashback, lower the angle and thread the needle
down the center of the fistula.
h. Tape the wings to stabilize the needle
i. Check for good flow.
 Consider Use of Wet Needles. Prime the fistula needle with saline and leave a
10cc syringe attached to the needle. Check for blood return, and then flush
carefully with saline to check for infiltration. Blood return alone is not enough to
show good needle placement- saline will be less traumatic to the AVF area
should an infiltration occur than blood and the blood pump
j. Apply a plaster/tape on a chevron method to keep the needle from dislodging
k. Release the tourniquet after inserting the needles
l. Secure wings using sterile gauze or adhesive bandage over insertion site, additional
plaster/tape as needed and replace the attached 10 cc syringe with needle tubing caps.
m. For dry needles, unclamp the needle tubing and allow the blood to flow to the end of
the tubing especially for the venous needle. Reclamp the tubing.
10. BLOOD SAMPLLE TAKING
  Any blood sampling for biochemical or hematologic analysis is done following vascular
access cannulation. Ensure that sample is not diluted with saline from fistula needle (if
used for needle preparation) by aspirating the arterial side and flushing it to the venous
side at least 2-3 times before obtaining the sample from the arterial side.
11. A patent and secured AVF access is now established hemodialysis can now be started.
12. Clean the area and discard the waste on the waste receptacle.
13. Document the procedure done.