Please describe how sites are to be rotated for a fistula.

S. Janes,

Fistula cannulation site rotation should occur from the time of the first cannulation. The fistula has an arterial (red needle) area and venous (blue needle) area. The arterial area is the portion of the fistula closest to the arterial anastomosis (where the artery and vein were surgically connected to create the fistula). The venous portion can extend as far up the fistula as the vein develops. Depending on how a fistula matures, the cannulation areas can be one inch to several inches in size. The idea of the cannulation site rotation is to use a different point for each needle stick. The points are moved up and down the arterial and venous areas. The same point may be used again, but should only occur once other points have also been used.

An easy way to do the site rotation is to start as close to the hand (lower arm fistula) or elbow (upper arm fistula) and move away from the starting point with each subsequent cannulation. Once the far end is reached, start back down at the beginning. The cannulation points should be separated from the next point by at least the size of the needle. The idea is to allow the area to heal between uses.

Site rotation with a new fistula is harder and will need time to progress. Trying a �new spot� is important to prevent aneurysm formations.

Deborah




[This message has been edited by Deborah Brouwer (edited 08-22-2000).]