Of the many issues currently being
addressed to improve arteriovenous
access for dialysis, cannulation has
received little attention. This session was
planned to address the specific challenges
encountered in cannulation for dialysis.
Leading off the program, Lesley
Dinwiddie, MSN, RN, University of North
Carolina-Chapel Hill, North Carolina,
addressed “The Challenges of Cannulation
in Dialysis Today.” She noted that the
Dialysis Outcomes Quality Initiative
(DOQI) recommendation for the creation
of more fistulas has led to the need for
more expert decision making with respect
to when and how to cannulate access.
Patient anxiety at the prospect of being
cannulated by someone whose cannulation
skills are unknown or have been experienced as lacking was discussed. The
need for dedicated expert cannulators
and the promotion of self-cannulation
were discussed.
Gaye Case, BSN, RN, Renal Care
Group, Jackson, Mississippi, presented
“Access Preservation: Single versus Multiple
Cannulators.” This unique study compared
the access history of 84 hemodialysis
patients divided into two groups: those
on home hemodialysis and those who
dialyzed in-center. Only licensed staff can-nulated
in-center patients and there was
relatively little staff turnover. Data collected
were numbers of accesses, access throm-boses,
and infections. The audience indi-cated
by a show of hands that they believed
the access of the home hemodialysis
patients who had a single cannulator for
more than 90% of their sticks would have
better survival. Surprisingly, there was little
difference in access survival, but there were
considerably more thromboses in
the in-center group.
The benefits and challenges of selfcannulation,
as well as the buttonhole
technique, were the subject of home
hemodialysis patient, George Harper,
MEd, Rome, Georgia. Due to pressing
patient advocate duties George had at
home (testimony at the State Senate), he
could not be present but sent a hard copy
of his presentation. The presider presented
his excellent tips on self-cannulation
based on 20 years of experience, as well as
his motivation to learn this art. Harper
strongly encouraged the professionals in
the audience to promote self-cannulation.
He also detailed his experience with the
buttonhole technique of cannulation,
and the presentation concluded with a
3-minute video clip demonstrating self-cannulation
of his buttonholes.
Rounding out the program was the
presentation of Deborah Brouwer, RN,
VASCA, Inc., McMurray, Pennsylvania, who
was a nursing representative on the
Vascular Access Committee of the DOQI.
She pointed out at the beginning of
“Cannulation Camp Revisited” that current
knowledge of cannulation is based on
experiential art and theory, and is not sci-entifically
tested. Cannulation of a new
arteriovenous fistula was discussed,
including choice of staff, patient educa-tion,
needle size, the use of only one nee-dle
and the catheter (and how to choose
which needle: arterial vs venous), pain
control, tourniquet use, and needle
removal. The differences in technique for
the matured fistula followed, and finally,
graft cannulation was reviewed. 
