View from the Chair: Learning to Self-cannulate – Tips from Fellow Dialyzors

Overcoming needle fear and learning a complex skill like self-cannulation is a challenge for many, and in some cases keeps people from trying home hemodialysis (HD), which could be their best fit in terms of lifestyle, values, and health outcomes.

Someone posted this question to the Home Dialysis Central Facebook Discussion Group: “I would like any personal insight on tips/suggestions that helped you during self-cannulation. I started dialysis last November. Fistula surgery & CVC implanted while it matures. So now I am learning to stick myself, but I seem to infiltrate every other day! My arm looks like it’s been through the wringer! Any words of advice or input on how to get over this? Any “tricks of the trade”? Thank you in advance!” Below are the tips people responded with.

Rope Ladder

• “I’ve done laddering for the past 2 1/2 years. I'd rather have a mild blood spray than an infiltration! Therefore, slow and deliberate is my guide. At 72 my skin is rather 'leathery' and tends to resist the needle's smooth penetration. I've overcome this by rotating the needle through 20 degrees or so either side of the median line of entry as I slide it in.”

• “My husband finds it easier to be precise and not go through the other side by going slow, and steadying his hand on his arm with the other fingers of his cannulation hand (i.e., he holds his needle between thumb and first finger, then uses the other fingers on the arm to be steady.) He goes in quite steep, then once he can feel the tip is in enough to be in the fistula, he changes the angle and goes up the fistula quite shallow.”

• “I use sharps and the ladder method. It’s important to go in at 45 degree angle then arch upwards. This keeps the needle from going straight through. I have only infiltrated twice in 3 years.”

• “I notice the clinics go very fast and all in one motion. I go very slow and just penetrate the skin then stop to feel if the needle is in the center of the fistula. Then, I penetrate the fistula and stop and then slowly push the rest of the way through. My nurse has seen this and said it’s not the way he does it, but to do whatever is comfortable for me. I have never infiltrated using this method.”

• “I stick only enough to get the bevel in to stop the bleeding. Then, I evaluate, and adjust the angle. Then I push a little more. Stop, wipe blood, and triple check the angle.”

• “Sometimes when my fistula is given me issues, I will find a spot then once I get the needle going I will literally close my eyes and do it all based on feel and feed back from my body. Your eyes can only tell you so much. And you might be getting information from other spots that could be useful. I never stick fast, but I also have never infiltrated myself. Godspeed!!”

• “Steady. Once you decide, don’t hesitate but don’t go fast. You can feel both sides of the needle (you’re holding one side and the other side is going in) so, if you concentrate you can minimize missing or going through the fistula wall!  Numbing cream can help or hinder, depends on the person!”

Buttonhole

• “I have had to create several buttonholes. The first time the nurse stuck me, then I followed that tract. I use blunt needles, but occasionally use sharps on the venous. Have the nurse watch. If you are infiltrating, you may be going too deep.”

• “Keep practicing. Maybe ask the nurse or tech to draw on your arm to help guide you. That seemed to help me. Then once I got a good stick and got a good treatment with that stick multiple times, I created buttonholes. There’s going to be some trial and error. But know with everything, practice makes perfect. You will understand the workings of your fistula with time and know where the best sticks will be.”

• “My vascular surgeon will take a surgical marker and draw where the fistula is located on the outside of our arm. Would that help you? There is also a little (ultrasound) machine that can be run over the fistula area that shows the fistula under the skin like an X-ray. Maybe your clinic has one and can loan it to you so you can become familiar with yours. Sadly, neither of these things tell you how deep it is, though.”

• “First and most important is a good nurse or tech. I used the best tech to learn how. I also use buttonhole technique. You have to imagine your vein is a straw you go in and then feed needle into the canal of the straw. Buttonhole is easy; you can feel the thrill. It only took me about 2 tries to get it. I do home, so I had to learn.”

We hope some of these tips will help you or your patients succeed at self-cannulation!