Happy National Dialysis Technician Recognition Week
Follow us on the Kidney Trails where the protein of knowledge never ends!!!
YEEEOOOOOWW!!!! “ ,” Oh my that kinda stung a bit!” ……….Ouch!!!””. Woooooo Weeeee….. This is madness!” (as she breathes heavily with eyes of disbelief) After I cannulated Mrs. AW with her fistula needles, flushed both of her access sites with heparin and normal saline, I had to give her a moment. “So Dwelyn , can I ask you something?”, “I understand it’s a needle, but why not just one? Why two? And will this be for every treatment I have? That’s 2 needles a day, 3 times a week, a total of 6 needles a week!!! “ I don’t even wanna think about it. I replied to Mrs.AW, “So sorry, but yes this procedure will require two needles each time, sometimes three Cannulation techniques and yes your mathematical calculations are correct with the numbers of needles and days and per week, give or take……” Wait , what do you mean sometimes three???? And give or take ??? “, “ Well what I mean by a possibility of three needle Cannulations instead of just two, simply because if myself or another staff member is unsuccessful with your Cannulation, we may have to insert another needle into your arm. “ No Maan!” “, I can’t beer eit( I can’t bare it was the phrase she used. Her Jamaican accent came into play. Like I said previously, Mrs.AW is very animated with her facial expressions)…. “ Well Mrs. AW, do you remember when months ago when you had your surgery for your access placement, your surgeon, or nurse, or anyone from the medical team explaining to you how important it is that once you have a fistula access, that exercising your vein is important for strengthening? When you do this throughout the day on a daily basis, it increases or as we like to say enhance the blood flow and improve arm vein tone. In this case it makes it easier for yourself and me or anyone of us here on the clinical floor to cannulate during your Hemodialysis treatment. Did you ever receive a squeeze ball in the shape of a ball or kidney? “ Mrs.AW replies , “ I remember vaguely, but a lot of things have happened the past couple of months. Ya know, when this Dialysis thing became a reality to me, or I guess once I’ve accepted it and left the stage of denial slowly, there’s too much to process in the moment and throughout. It’s a life change I’ve never could’ve imagined. So to answer your question, they may have told me but I forgot. “ Point Taken Mrs. AW, that’s why we are here to remind you and all of our patients about their care. We are family. “ Thank you Dwelyn. That helps because I have a lot going on.”, Understood, now let’s start your treatment and get this show on the road.!” ,” Wait, Dwelyn before you start, what was in those syringes you pushed inside of me?” , I think I could taste a funny taste in my mouth. Maybe I’m exaggerating( shaking her head) ………….( “ As I snickered with my reply. It’s amazing how all the years I’ve been a Nephrology Clinical Technician, the questions that are asked by our patients. I tell you , you never stop learning. I mean when you’re on this end of spectrum, and I mean when you’re the person giving the care, or providing the treatment. It sometimes never occurs to you the What If’s? Or you say to yourself,” I’ve never thought of that, hmm!” . Everyday is a learning experience)…….. “ Mrs. AW you’re definitely not exaggerating. Well in one of the syringes there was a medication of heparin. You have an order for three thousand bolus of heparin . The other two syringes were normal saline flushes. The heparin was prescribed for you to prevent from your blood clotting during your treatment and the normal saline flushes were used to test patency in both of your needle Cannulation sites. “ Dwelyn is my body of blood clotted? “ , “ Oh no I didn’t know!” And who is Payton!” “ LOL, no Mrs. AW, the heparin is only used for and during your dialysis treatment so not you as an individual’s body of blood clots off, but primarily for the system setup I have here in place for you. So once I initiate treatment for you, I will explain this process from beginning to end.” Now this Payton person you’re speaking of is pronounced “ Patency”. Which means we are testing for openness to your access, to detect any blockage, for myself to make sure my needle is tunneled properly, and most importantly to reduce the pain level for you and our patients while giving care. If the Cannulation isn’t tunneled properly, it’s a possible chance you could experience an arm infiltration. “ A what?” ,” Oh boy, there’s a lot words you saying I don’t have a clue about!” “ This is a lot !” ,” Don’t be alarmed. Remember I said we are family and we are here to remind and guide. “ An infiltration is like swelling of your arm access that can be very painful and traumatic. If the cannulation technique isn’t done properly and taken the proper time, we could have an issue. So it’s very important for us as staff members to follow the proper procedure to clean the whole arm access for both fistula and grafts for Cannulation, for everyone with a fistula to use a tourniquet, listen for the bruit with our stethoscope, and feel for the thrill. Everyone doesn’t have an order or prescription for heparin , but we must always test for patency. This process makes the treatment a little bit easier or more sustainable for our patients. And most of all it’s safe and clean….. ” Dwelyn I think I get it kinda. It makes sense once you explained it to me. I thank you. “, But I wanna ask , if you don’t mind… So this squeeze ball thingy is supposed to help my arm by me squeezing it all day everyday?”….. Indeed it does to help strengthen your arm vein.” So what if I get tired of squeezing?,” Well Mrs. AW , you don’t have to squeeze it all day, just maybe five minutes a day , each day. Or you could just make a repeated fist back and forth throughout your day when you’re just sitting around watching television, listening to the radio, taking a walk , shopping or etc….”. “ Makes sense Dwelyn. But I do have a bit of a circulation problem in my hands. Especially this hand where my fistula is. What if I can’t squeeze a ball anymore or lose strength in it?” Will my access give up, stop working or die?”…… Well I can recommend a device you could purchase online if you’re a online shopper.” …. “ Oh my! Yes I am an online shopper. I have nothing else to do with my life but go home and shop. I brought my iPad with me today because I didn’t know how long I was going to be here. If that’s okay.” ….. “ It’s definitely okay. Well I recommend a device, if you choose to purchase on Amazon to be exact. I myself know during this time of the COVID-19/ Coronavirus, a lot of people are shopping more online than ever before due to being safe. And all of our patients are at more risk with effects to their immunity. So I definitely get it with the precautions of social distancing. In your case as a kidney patient access care is highly important. The device is specifically for arm vein fitness, arm vein exercise, improve or endurance of the flow, increase the energy and strength of the arm vein for wellness, improve muscle size and tone………. it’s called Fist Assist!”……… Dwelyn this sounds amazing for someone like me who just simply can’t just squeeze a ball. But will I have to squeeze this Fist Assist thingy?” ….. No it’s fully automatic with the touch of a button once it’s wrapped around your arm. The comfortability of the device is manufactured with a Velcro strap to hold in place. It’s like it’s soft vibrations to your arm. Think of it as being Automatic For The People. All People…….. I love it. With this talk of improving my access and getting through this procedure has really helped. It makes it easier for me. I will definitely check into this Fist Assist Device later on.” , “ Okay great Mrs.AW, I will connect your lines from your machine to your access and we will start treatment.”…… ( After our brief conversation about access, I stop my blood pump, prime both my arterial by gravity and venous lines in the priming bucket with the pump on, stopped my pump, marry my lines together, clamp both venous and arterial, three clamps for my saline line, manage my pump segment to ensure it’s secured and locked, no transducers are wet, chambers full both arterial and venous, check my orders for Mrs.AW’s Treatment…..goal,time,dialysate flow,blood flow,profile ,sodium variation,acid and bicarbonate bath,….. I use a hemostat clamp one to her upper shoulder, applied tape around her upper arm, and once again checked my Dialyzer headers to make sure they’re tight and secure. We don’t want any leaks of water and most definitely no leaks of blood, I unclamped her lines and turn my blood pump up to 150 speed and then 200 speed slowly )…..Mrs. AW replies with eyes as big as the movie Roger Rabbit when he was excited or one of those keychain toys you squeeze and the head inflates…. …” Dwelyn, I have more questions.” “Where is my blood going and coming from my body????