Table 3.

Strategies to promote changes in cannulation

Patient Prepare the patient for cannulation in advance by explaining the procedure and what to expect Discuss ways the patient can cope with the cannulation, i.e. relaxation techniques, slow deep breaths, distraction with music

Environment Plan in advance for first or difficult cannulation Consider a cannulation team Ensure quiet environment with reduced patient assignment Have appropriate equipment for assessment Cohesive teamwork Documentation/communication of individualized patient plans of care

Nurse Education on the technical aspects of cannulation Education on advanced assessment of the AVF Developed communication skills Nursing care that is patient centered Develop emotional intelligence in staff Comprehensive orientation program for cannulation Opportunity to practice skills Mentoring program for cannulation Use ultrasound to assist with cannulation and consider real-time ultrasonography for cannulation Support staff available for assistance during difficult cannulation Acknowledge the patient and nurse emotional response to cannulation