Infection Control in the Dialysis Setting Part 2 of 4

1. Infection Control in the Dialysis Setting Part 2 of 4 Danilo B. Concepcion CCHT, CHT Manager, Renal Technology Services Email: danilo.concepcion@stjoe.org Phone: 714.771.8944 The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of St. Joseph Hospital

2. BUTTONHOLEor a.k.a.CONSTANT SITE

3. What You Need to Know • Requires the same cannulator to form the tunnel • If the patient is a good wound healer, it may take 8-10 cannulations • If the patient is a poor wound healer, it may take 12-14 cannulations

4. What You Need to Know • Reuse same sites each treatment with blunt needles • Scab removal ~Most important to prevent infections • Must follow the track/tunnel of the original cannulator

5. How Do the Needles Differ? Reprinted with permission of the American Nephrology Nurses' Association, publisher, Nephrology Nursing Journal, June 2006, Volume 33/Number3.

6. Infections Can Occur If… • Improper skin cleansing • Improper scab removal • Contaminated needle • Improper cannulation of the track systemic localized Used with permission of Dr. Tony Samaha

8. Current Cannulation Techniques: Bad One-site-itis Good ButtonHole Good Site Rotation

10. Don’t flip the scab off with the needle you will use for cannulation – this contaminates the needle. Don’t use a sterile needle – you could cut the patient’s skin. Don’t let patients pick off their scabs. Don’t stick through a scab – remove it Do use either: ~aseptic tweezers; ~soak two 2 x 2s with NS or alcohol-based gel; ~place a warm, moist washcloth over sites; ~stretch skin around scab in opposite directions; ~have patient tape alcohol squares over sites prior to dialysis. Do’s and Don’ts of Scab Removal

12. Benefits for the patient • Less painful – elimination of anesthetic • Fewer infections • Fewer missed needle sticks • Fewer infiltrations • Cannulation of access takes < 10 seconds Twardowski, 1995