For most people undergoing dialysis treatments, in-center dialysis is the most common modality of dialyzing for one simple reason–the needles.
Dialysis requires the insertion of two large needles into a patient’s vascular access so that blood can flow from the body to the dialysis machine to be cleaned, and then flow back into the body. A healthcare professional will typically insert the needles for people on in-center dialysis. People on home hemodialysis either have a care partner insert the needles or they insert the needles themselves.
For many people, the thought of using a large needle is intimidating and anxiety-inducing. I think almost anyone will tell you that they would never choose to put their own needles in or take them out for dialysis treatments. It can even be enough of a deterrent to stop some people from considering home hemodialysis. However, once people realize the control they gain by self-cannulating, it opens their eyes to how empowering it can be.
When a person inserts his or her own needles, it’s called self-cannulation. People tell me that one of the biggest benefits to self-cannulation is the control they have over their treatments. I remember one person was very resistant to putting his own needles in, but after self-cannulating for the first time, said that he would never let anyone else do it again. He compared it to putting a cotton swab in your ear–would you rather do it yourself or have someone else do it?
You are the only one that experiences how the needle feels once it’s in your body. So, when you cannulate your own vascular access, it is less painful. Needle placement
is typically better when you place the needle yourself rather than having someone else do it. When you self-cannulate, you are in control of where the needle goes and how
it feels once it’s in. Self-cannulation gives you control over your
In addition to being less painful, many people’s accesses last longer when they learn how to self-cannulate. Your vascular access is your lifeline, and you are the expert for your own access. You notice slight changes or issues much earlier than someone else would and can advocate for yourself. When you self-cannulate, you can typically experience fewer infiltrations and complications.
Self-cannulation also opens the door for people to transition to home dialysis. Home dialysis allows for more flexibility in your treatments, including the ability to do your dialysis treatments in the comfort of your own home. Many people choose to dialyze more frequently on home dialysis because it more closely mimics the normal continuous function of your kidneys. You may also have more flexibility in your diet with more frequent treatments. Finally, one of the biggest benefits of home dialysis is that people can travel more easily than when they do their treatments in-center. Many people also say that they feel better and have more energy on home dialysis.
So, you’ve decided you want to learn self-cannulation, but where should you start?
Start at the end and work your way toward the beginning. Removing your needles is less intimidating than inserting your needles, so I’d recommend starting there and gradually taking on more of the process yourself as you gain confidence and feel more comfortable. We have lots of practice tools that we use when training people to self-cannulate so that they can get a sense for how much pressure they need to apply when inserting the needle, what positioning is most comfortable, and other parts of the process.
When you are in training, your care team is also a great resource. Ask to be a passive participant in inserting your needles with your care team–hold your hand over his or her hand when inserting the needle– and then switch roles during a later treatment. You may also want to consider reading glasses, a headlamp, or other tools which people have said help them feel more comfortable when self-cannulating.
If you’re interested in learning self-cannulation and taking control of your treatments, talk with your care team and learn about your options.
Michelle Carver, BSN, RN, CNN, is the Vice President of Clinical Services Initiatives at Fresenius Kidney Care. In this role, she develops programs to improve the quality of care and clinical outcomes for individuals on dialysis. Michelle has more than 25 years’ experience in nephrology and is passionate about empowering patients to self-manage their renal disease. She lives in Nebraska and enjoys biking, hiking, and spending time with her family.
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