Table 4 Patient quotes regarding cannulating-related problems and clotting of the dialysis circuit or vascular access

Cannulating

Experience

Pain

“Have pain in the access area.”

“…if they hit a nerve…it causes pain throughout the entire run, which is really not comfortable.”

Prolonged Cannulation

“Do we actually lose time? If it takes a half hour to stick us, do we cut that time off”

Infiltration

“Bad sticks that lead to infiltration, short treatment or almost no treatment.”

“I had a bad run when I was stuck wrong and my blood was oozing out of my venous line and it came out even more till we had to stop the treatment….”

Perceived Causes

Staff skill or technique

“One time I had the needles put too close together and after all…three and a half hours of treatment, I was never dialyzed…that was a bad thing.”

Staff knowledge of patient

“…you have some techs that are really familiar with you, they can…get you in, Some techs

you’re just kinda nervous about ‘cause they may or may not infiltrate you, which means you can’t dialyze that day.”

Perceived Solutions

Patient-driven

Requesting a different staff member

“…patients ask other techs to see if they can put you on as opposed to that particular tech that you’re assigned to.”

Change access type

“It could also involve being infiltrated by the person cannulating me, which is part of the reason I switched to buttonholes.”

Clinician-driven

“Ice pack on the infiltration…”

Clotting

Experience

Clotting of Access

“Sometimes it could be a problem with your access site, it might clot off for whatever reason.”

“…I go in early, go in and they take the stethoscope, listen for the thrill sound if it’s running and if it’s not that’s a bad run; cause I can’t run. I now have to go in and get a de-clot.”

Frequency

“Yeah. Two weeks in a row.”

“It could also involve clotting, which rarely occurred.”

Shortened or Missing Treatment

“Sometimes it could be a problem with your access site, it might clot off for whatever reason and most of the time people who end the treatment early just don’t feel well, they just wanna get off the machine.”

Perceived Causes

Blood Disorder

“The problem is, is that my graft doesn’t follow the rules. I follow them, my graf doesn’t. …because I have a blood disorder, that clots.”

Perceived Solutions

Patient-driven

 None

Clinician-driven

Surgery

 “I have to wait till the surgeon can get me in, to do a de-clot.”

Medication

 “I’m not sure if all of the patients are having to go without heparin if they’re on Coumadin now, but I believe that’s what our unit was following. They have to give me heparin.”