1. Addenbrooke’s and the Rosie Hospitals – Innovation and Excellence in Health and Care Self Cannulation Technique Regin Lagaac Clinical Nurse Specialist Vascular Access Cambridge University Hospitals NHS FT

2. Addenbrooke’s and the Rosie Hospitals – Innovation and Excellence in Health and Care Benefits of Self Cannulation To promote self-care for those of you who have matured arterio venous fistula (AVF) access To reduce anxiety regarding needle insertions, infiltrations and infections.

3. Addenbrooke’s and the Rosie Hospitals – Innovation and Excellence in Health and Care Matured arterio venous fistula A fistula has been cannulated for two months without any problems or complications with a blood flow of more than 300 ml/min.

4. Addenbrooke’s and the Rosie Hospitals – Innovation and Excellence in Health and Care Selection criteria A dialysis nurse will identify haemodialysis patient who are capable of cannulating their own arterio venous fistula and who met the inclusion criteria

5. Addenbrooke’s and the Rosie Hospitals – Innovation and Excellence in Health and Care Inclusion Criteria a. Working fistula for more than two months without any complications b. Blood flow of more than 300 ml/min c. No cognitive impairments d. Not visually impaired e. Non graft fistula

6. Addenbrooke’s and the Rosie Hospitals – Innovation and Excellence in Health and Care Pre Training Considerations l The location of the vascular access l Adequate lightning l Positioning l Vision: Does the patient wear glasses? Does the patient need to wear some type of bi-focal lenses (reading glasses) l Hearing (check bruit and thrill) l Evaluate stenosis using USS machine, measure recirculation percentage and access flow, dialysis adequacy (URR and Kt/v)

7. Addenbrooke’s and the Rosie Hospitals – Innovation and Excellence in Health and Care Pre Training Considerations l Patient desire to learn self care l Basic manual dexterity l Agreement to comply with self-cannulation policy and procedures. l Has achieved basic compliance with universal precautions. l Time frame: 2 to 3 weeks

8. Addenbrooke’s and the Rosie Hospitals – Innovation and Excellence in Health and Care Self Cannulation l allow the patient to observe your needle placement technique. l allow the patient to watch cannulation videos for AVFs l the use of skin marker is helpful in aiding the patient to visualize the direction of the vein, especially during the initial phase of self cannulation. l Tattoo the fistula as a guide in cannulation

9. Addenbrooke’s and the Rosie Hospitals – Innovation and Excellence in Health and Care Clocking and Skin Marker

10. Addenbrooke’s and the Rosie Hospitals – Innovation and Excellence in Health and Care Infection Control Our protocol consists of the patient 1) washing the hands thoroughly 2) cleaning the skin over the vascular access by washing with antibacterial soap Procedure can be accessed online: http://connect/media/pdf/l/q/Self_cannulation_of_arterio_venous_fistula_ve rsion1_April_2014.pdf

11. Addenbrooke’s and the Rosie Hospitals – Innovation and Excellence in Health and Care Self Cannulation