Clamping both accesses at the same time?

[JVT90]

Is it bad if the techs clamp both sides of the graft at the same time?

[cassandra]

Are they using clamps because you can't hold the gauze? And one nurse at my clinic said clamping both is okay. But I personally would try to hold them myself if in anyway poss.


Good luck, Cas

[iolaire]

I recommend talking to the nurse about the clamps, especially your question on using two at a time. 

My gut feeling is that its probably best to alternate clamping, but the techs are rushed and will do both sides if you don't request otherwise. This document says it should be one side at a time, but really they should be held:
http://www.therenalnetwork.org/qi/resources/VA_Solutions_Staff/11.ClampUsagePolicyandProcedure.pdf
Policy:
Using clamps on new or underdeveloped fistulas is prohibited. 
The use of clamps post-dialysis to hold sites for mature fistulas and grafts should be restricted.  If and when clamps are used on a mature fistula or graft, use one clamp at a time to prevent excessive pressure/thrombosis. Patients and/or family members should be instructed to hold sites, and if this is not possible, staff should hold access sites.


I was always told that clamping is bad for the fistula and will make it have problems much sooner.  But I could hold both bandages fine and was interested in my care.  I'm sure they didn't tell that to frequently the 80% of the people in the center who were using clamps, even people who probably could have held their own bandages.

[Rerun]

We have a fairly new rule at my DaVita Clinic.  One clamp at a time on fistula or graft.  If you hold you can do both at the same time with your fingers.

[GA_DAWG]

My neph does not allow clamps to be used.

[JVT90]

Thank you all for responding. I surely appreciate you all weighing in. My husband is unable to hold his sites (blind/stroke affected). Up until recently they would clamp one at a time. The last few times they put the clamp on both at a time. When he questioned the first tech about why do that? Aren't you supposed to do it one at a time so it won't clot? They told her every once in awhile wouldn't hurt. He was so upset worrying that it would damage his graft.

[Michael Murphy]

Many clinics forbid clamps.  My clinic will assign a tech to hold the sites if the patient is not able.  My understanding is that clamping is bad for fistula.  In another note I discovered something that gets me out quicker.  I have sure seals put on the sites with folded gauze taped over the sure seals.  After 5 to 10 minutes I have 4 inch vet tape (elastic self sticking) loosely wrapped around the sites.  It works to hold the sites till I get home.

[GA_DAWG]

That is what they do at our clinic also Michael. The techs hold the sirtes of anyone who cannot hold their own. The nurses have to help with this also.

[Charlie B53]

As long as I am actively reading or viewing a video I can ramain awake, but have me sit still and hold pressure on a site I will fall asleep, my finger will slipp, and I will bleed.  So we clamp.

Depending on which Nurse is on that day I can have two clamps together.  Next week will be the other Nurse and only one clamp at a time.

I am in the 'last' chair, the techs are maxed out on patients o I usually always have one of the Nurses stick me.  If an alarm sounds the nearest body responds.