Great issues have been posted on the RenalWEB discussion boards. How did you learn about dialysis?
1. Dialysis unit provided orientation and information
2. Self taught by your own reading and research
3. Profession organizations
4. Meetings
5. Journals

What do you think is the most effective way to get ideas across to dialysis personnel? Keep up the great postings. We can all learn from each other. Thanks.


[Note: This message has been edited by Deborah Brouwer]

I blew a patient's graft a year ago and have lost my nerve. I only stick easy fistula and grafts now. I would like to regain my confidence and be the hot shot I once was.

What is the most realistic device/substance/animal organ to practice needle cannulation on? Somebody said try beef hearts.

The only way I even attempt something new is when I bring in documentation supporting it. Whether I get it from the www sites or postings like this or information from periodicals and professional journals. Otherwise it is too hard to get the experienced nurses to see the other side of the coin. (I'm an LPN who's been in HD for ~ 1yr now.) The task after the initial trial is to get nurses to trial it (whatever the new thing is) more than once to see if there are any trends...any hints? I also find it quite hard to get other nurses (LPNs) to take the next step with the critical thinking process...any hints on how I can get them more involved in the total process?

Gun Shy,

We all have bad cannulation experiences. The difference is staff like you wanting to learn and improve their cannulation skills! You can practice on a sample segment of PTFE graft. The best thing would be to try again.

You might ask another staff member that has "no problems" with a "hard access" to stand near by while you attempt the cannulation. If the other staff member needs to assist you with the cannulation, talk about the cannulation after the procedure is completed. Discuss
the technique differences that they used to cannulate the access without problems. Another way is to talk about a specific access before the cannulation. You might want to watch another staff member cannulate a �hard access� and then you try the cannulation the next treatment.

Patients will respect someone like you who cares about their arm as if it was your own arm. So go for it. Slowly build back up to the hardest access in your unit. A long as you keep learning and asking question, you can do it.


[Note: This message has been edited by Deborah Brouwer]

Jeanine,
Dialysis staffs like things to be the same, such as the same routine everyday. You are right about it being hard to get others to try new things. The mind set is a �why bother�. Staff may think the task is too hard. It might be best to find an issue that causes the staff a lot of wasted time and effort. Then suggest they think about what steps in the current process appears to be the problem. Ask how they would change things if they could. Then try to change the process slowly with one step at a time. A big problem broken down into smaller issues can help the staff to problem solve. Does your unit have a QA, QM or CQI program? The CQI process would work well with someone like you. You are interested and want to make improvements. Lots of good CQI ideas have been published. You might find one that your unit could try. Many ideas have the CQI trending tools included with the publication.


[This message has been edited by Deborah Brouwer (edited 06-28-2000).]

Could you tell what is the best way of finding information related to a particular topic area i.e. which website to use for search purposes. I plan to do a literature review on cannulation techniques and need some guidance. Thank you.

I use Medline. You can access it for free through Pubmed. I have found it to be very helpful.