Any ideas on why a patient would have a sensation around arterial needle/site like that of when someone has a cut and alcohol touches cut. sensation of stinging? Also, why would flipping of needle for the above be required? Thx.

The stinging could be related to the alcohol or betadine used to cleanse the site.

Sometimes just moving the needle will ease that sensation

I heard that flipping the needles can damage the fistula. Even though my nurses used to do this all the time when I had working buttonholes (in the process of being developed).

With the current JMS syslocs, the needle actually can be rotated 360 degrees independantly of the hub. Basically the needle itself turns while the wings stay in place.

Sometimes flipping the needle will help with the stinging because the angle of the needle changes slightly with in the access. Do it CAREFULLY and with caution, but it seems to help some of my pts.

flipping needles made easy by rotating hubs, maybe too easy! Flow problem?.. flip the needle first thing! Maybe simple reposition would work too. Rotating the sharp cutting bevel of a steel needle inside the access will no doubt cause some coring of the intima. Maybe use non-rotating needles only so nurses have to work to flip... untape, flip and retape.

There is nothing inherently wrong with flipping needles though there has been a movement against this procedure in recent years. I believe Fistula First recommends NOT flipping; I may be wrong. I will check their website and encourage all of you to do the same.

Flipping can cause damage if needle bevel is not completly in vessel and caught on side/intima. Make sure there is good flashback before flipping to avoid this problem.

Most people flip because they were trained to cannulate that way and have not pondered what is happening when they do. My favorite bad answer in the medical field (and life) "because we've always done it that way".

I have changed my cannulation technique and only flip when absolutely necessary.

As always, follow clinic policy and procedures. Dust that old book off and you'll be amazed by what you find; you may actually understand the rationale behind why you do things the way you do or will find your doing many things the way you should not. Want to impress management; find policy or procedure that needs to be updated to current practice trends and get rid of antiquated policy/procedure.

Nipro, JMS and Medisystems all have rotating hub needles, though some tend to flip on their own when cannulating; that can cause coring issues. Pay attention to this when evaluating the products.

The stinging could be caused by the needle touching a nerve. As for flipping, it should not be done! Most arterial needles now have a "back-eye" which should eliminate the issue of the needle sucking up against the vessel wall, which was why needles used to get flipped originally. If using a 2-needle pack, make sure the needle with the back-eye is used for the arterial flow.

Flipping needles started with all of you new folks who learned how to cannulate with Grafts. Fistula First advises not to flip..Flipping is not Fistila friendly.