A look back at “Cannulation Camp”

Abstract

When writing “Cannulation Camp” back in 1995, I never imagined the article would have such lasting impact on the nephrology community. I first want to thank the people who made the article happen. Joseph Herman was the editor of D&T at the time, and he decided the article should be the first-ever full-color article published in the journal. The color was necessary due to the amazing illustrations created from my very crude drawings. The concept for the article was conceived thanks to Mitchell Henry, MD and the Ohio State's “Vascular Access for Hemodialysis IV” symposium in 1994. Dr. Henry chose me to present “Hemodialysis: A Nursing Perspective” to a mainly surgeon audience symposium. Susan Boothe, RN, MS, is the product specialist for vascular access at W.L. Gore & Associates, who published the symposium book, and she coordinated the creation of the illustrations by the Gore medical illustrator. The illustrations where initially used to create slides for the presentation, and subsequently used in the black-and-white format for the symposium book. Joe Herman saw the need to spread the cannulation information from the symposium to the wider dialysis community, and thus “Cannulation Camp” was written. Once the article was published, my hands-on training course and lecture presentations for dialysis professionals was termed “Cannulation Camp.” I have lost track of the number of professional educational programs that have resulted from “Cannulation Camp,” but it has traveled to many small and large towns within the U.S., as well as to countries around the globe. The publication of “Cannulation Camp” also led to one of the most rewarding volunteer efforts I could ever have imaged—I served as a Work Group member for the KDOQI Vascular Access Guidelines for the 1997, 2000, and 2006 versions. Thanks to Steve Schwab, MD, and Anatole Besarab, MD, for selecting me as one of the two nurses honored to represent our profession and, even more importantly, the hemodialysis patients in the original Work Group. I have been truly honored to remain on the 2000 and 2006 Work Groups to update the guidelines. The guidelines led to the Centers for Medicare and Medicaid Services creation of the National Vascular Access Improvement Initiative. Thanks once again to the publication of “Cannulation Camp,” I was selected to be one of the original Work Group Members that formed the initial Change Concepts, now widely accepted, and the Fistula First Breakthrough Initiative (FFBI). It is fair to say my work as a nephrology nurse volunteer to help improve the vascular access options for all chronic kidney disease patients began with the publication of a simple “how to” cannulation guide! AVF maturation for needle cannulation—how, why, and when an AVF matures; The best method for new AVF cannulation—buttonhole or self cannulation for all HD modalities (not just for home HD); and Needle-placement direction and bloodflow rates—whether they impact the formation of aneurysms or create vessel damage. An important correction to “Cannulation Camp” was discovered when I was reviewing one of the many KDOQI 2006 reference articles. The theory of recirculation based solely on needle distance was disproven by Basile and colleagues in 2003.1 This study found that the recirculation was not related to needle distance, but to bloodflow (access flow) within the body of the fistula in relationship to the blood pump flow rate. For example: AVF access flow of 800 mL/min and the HD blood pump set at 500 mL/min = no recirculation regardless of the needle distances (2, 5 or 11 cm). But, if the AVF access flow is low at 400 mL/min and the HD blood pump set at 500 mL/min = recirculation. The venous blood pulls dialyzer blood backward into the arterial needle due to the lack of adequate flow to meet the demand of the blood pump on the arterial needle. For the most current recommendation on the proper techniques for AVF cannulation, please use the many outstanding references found on the Fistula First website (www.fistulafirst.org). I want to personally thank several of the key cannulation educators who have helped me over the past 28 years in nephrology nursing: Susan Boothe, Patt Peterson Ryder, Janet Holland, and Kay Bregel. I also want to thank D&T for the amazing opportunity to use simple words and simple illustrations to help teach so many nephrology professionals about the importance of hemodialysis vascular access cannulation, and for the many years of providing a journal that reaches the frontline care givers in dialysis units around the globe. D&T has supported the dissemination of updated nephrology information to people who can use the information to improve the care and lives of chronic kidney disease patients. The journal will be missed. Thanks for 40 years of service to the nephrology community!