Single-Handed Touch Cannulation and Chevron Taping for Solo Home HD
Pioneered by Stuart Mott a decade ago, Touch Cannulation involves holding the needle tubing rather than the wings. By holding the tubing a few cm back from the needle hub, greater sensitivity is achieved determining the location, depth and direction of the fistula. A clear view of the tubing immediately behind the hub is afforded. Here the pulsing of the blood column (flashback) indicates how freely the needle tip is moving through the vessel. In this way probing for the “sweet spot” (needle all the way in, eye free of the endothelium) is facilitated.
Consider: with conventional cannulation, the fingers hold the wings which are attached at right angles to the hub, and the hub in turn is attached to the needle. With touch cannulation, the fingers are attached to the tube that runs directly to the needle - surely putting the cannulator more “in touch.”
The charm of HHD is ever the development of individual technique. Troubled by inability to achieve satisfactory taping by the chevron fold method single-handed, I trialed applying the tape to the needle hub BEFORE sticking. The wings are an unnecessary encumbrance and superfluous anyway if using touch cannulation. They are designed to be readily twisted off by hand. The image (1) shows the needle upside down with tape stuck to the hub. One arm of the taping will be firmly wrapped once round the hub; therefore ensure the wrapping section is longer to accommodate this (2).
The images that follow show touch cannulation and applying the widely approved chevron fold for securing the needle. I am fortunate with a clear “stickable” fistula that does not actually require the touch technique for most of its length. At the upper end however it dives deep into the arm and becomes invisible. Here gentle probing and careful observation of the flashback allows maximum utilisation of the fistula’s length.