Single-Handed Touch Cannulation and Chevron Taping for Solo Home HD

This blog post was made by Ant de Villiers on October 4, 2018.
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.

Comments

  • Erich Ditschman

    Oct 09, 2018 3:44 AM

    Looks good to me. I've been sticking myself for home hemo for the last twelve years. Of course, they've all been single handed. I place a bandaid over the insertion point and then do a chevron. I then add a strip of 3M silk tape. Then I offset another strip of 3M silk tape. Finally, I'll cover the area with 3 squares of 3M Medipore tape. I repeat this with one offset above the first and one below. For the past 10 years, I used this extra taping since I hemodialyze while sleeping 8 hours a night. Nice technique Stuart.
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  • Vernon Scharp

    Oct 04, 2018 11:48 PM

    Presently “making” button holes. Do you think this technique would work well with the “dull” buttonhole needles?
    Thanks
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    • Stuart mott

      Oct 06, 2018 9:10 PM

      That's exactly why I touched cannulation was invaded for buttonholes Google touch cannulation and explains the whole situation for which I developed it for it is now used all over the world and how I know this is because I get emails from all over the world asking for the questions that include Saudi Arabia Australia especially Japan Canada South America you name it it has come in through emails asking me questions about it if you yourself have any questions about it please call me at area code 578-2682
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    • Ant

      Oct 05, 2018 11:14 PM

      Sure. S. Mott the founder of the technique expressly developed it to offset damage being inflicted to buttonholes.
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  • Amy Staples

    Oct 04, 2018 7:21 PM

    We've never had "sterile" cloths available to use. I would think clean ones would be sufficient considering the needle is unexposed. Thanks for the wonderful visual aids. Another great stride in solo cannulation and with the touch method. Blessings
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