At a Renal Stand-Still
The last forty years have seen great strides in medical advancement. Synthetic insulin has improved the diabetic world for humans and animal subjects alike. Laser eye surgery made corneal correction viable and affordable. Radiosurgery armed us with a wonderful new weapon against epilepsy. The human genome project reached bedside, unlocking endless potential therapies. Considering the advances in almost every conceivable area of medicine, it is equally inconceivable that certain basic training needs haven’t been addressed at all…
This spring will mark my 40th anniversary as a dialysis nurse. I was fortunate, discovering my area of interest very early—at my first dialysis job orientation, in fact. AV access, particularly cannulation, has received most of my focus over the last four decades. If only medical advancement had shared my interest.
After the orientation, I was surprised to find out that my training was on-the-job, with only a cursory glance at theory and practice. A preceptor demonstrated proper cannulation, then simply handed the needles to me.
There was no fake arm on which I could practice. There was only an arm made of flesh and blood, attached to a patient who didn’t deserve to be a medical crash-test dummy.
Since then, I’ve worked to innovate cannulation training methods, techniques, and devices. There are many avenues for improvement, but the problem (as usual in medicine) is the sheer size of the hemodialysis industry. First, we need better fake arms, and a lot more of them. Second, we need standardized assessment criterion for the individual elements of cannulation: for example, angle of entry to reach the center of the target vessel. Pressure on the needle should be measured, as well as adjustment of needle angle. Both should be explained and assessed separately so that trainees can understand and master each skill, adding up to safe, effective, minimally invasive cannulation.
Obviously, all fake arms and simulators will need to be cheap enough to allow for global affordability, and ideally, broad enough utility that patients could learn self-cannulation as well.
There is much more work that needs to be done. I have aggregated the complete Hemodialysis Instructional List, including “what needs to be done,” “how it can be done,” and in some cases “with whom it should be done.” Click the link to read the complete article as I wrote it for Renal Interventions.