Post by jnewton on Mar 9, 2024 1:59:29 GMT
Hello....I have just began giving my wife hemodialysis at home. Tonight I inserted the needles as I had before, aspirated 10cc of blood and returned it with no problem from either needle. I flushed the venous access with 1000u of heperin as I was taught to and connected her to the NxStage machine. As soon as the machine began cycling the venous line infiltrated and I had to discontinue the dialysis session.
Now as an RN for 30 years I am no stranger to starting and running IVs, but I have noted that hemodialysis is a bit different. Got some questions....
1) If an infiltration occures, if it is caught immediately, does dialysis have to be discontinued? Is it possible to pull the needle back a bit, reposition, wait about 45-60 seconds for clotting of the unintended puncture, and resume the dialysis session?
2) While in training I asked the instructor How far to insert the needle, she instructed all the way. I am using a 16G 1.6 inch needle. I realize that you have to have it in far enough to flow blood without leakage, however, once you have pulsating flashback in the line and you still have over an inch of needle to insert it would seem to me that any more advancement further than another 1/2 inch would just increase your chances of piercing back thru the vein. In short, would and inch of that 1.6 inch needle in be sufficient for running dialysis? Does it always have to be buried to the hub?
I still cant figue out really what happened. I freely aspirated blood from both the arterial and venous lines, then returned it with no resistance. As soon as I started the dialysis machine you could tell it was infiltrated....not badly for I caught it instantly. Normally I am use to using 24g 3/4 inch needles to run fluids and antibiotics but these long 16g needles are new to me. Any thoughts and advice here would be appreciated.
Now as an RN for 30 years I am no stranger to starting and running IVs, but I have noted that hemodialysis is a bit different. Got some questions....
1) If an infiltration occures, if it is caught immediately, does dialysis have to be discontinued? Is it possible to pull the needle back a bit, reposition, wait about 45-60 seconds for clotting of the unintended puncture, and resume the dialysis session?
2) While in training I asked the instructor How far to insert the needle, she instructed all the way. I am using a 16G 1.6 inch needle. I realize that you have to have it in far enough to flow blood without leakage, however, once you have pulsating flashback in the line and you still have over an inch of needle to insert it would seem to me that any more advancement further than another 1/2 inch would just increase your chances of piercing back thru the vein. In short, would and inch of that 1.6 inch needle in be sufficient for running dialysis? Does it always have to be buried to the hub?
I still cant figue out really what happened. I freely aspirated blood from both the arterial and venous lines, then returned it with no resistance. As soon as I started the dialysis machine you could tell it was infiltrated....not badly for I caught it instantly. Normally I am use to using 24g 3/4 inch needles to run fluids and antibiotics but these long 16g needles are new to me. Any thoughts and advice here would be appreciated.
