Hello Dr. Agar,
Recently I had an infection on one of my buttonhole sites and fever. I was prescribed antibiotics. For the last four weeks, I have been taking different antibiotics like Amoxyclav, Clindamycin, Vancomycin (IV), Teicoplannin (IV). The fever has gone but there is a persistent discharge from the infected site. It has reduced from what it was initially but even after four weeks, it has not stopped completely. I visited the vascular surgeon who spoke to my nephrologist and has now suggested that I start Cefuroxime and take it for two weeks.
I was wondering if a fistula infection could last so long and what a persistent discharge from the site means. (While I understand this is a medical problem and I am in constant touch with my care team, I just wanted to know if this is something that is common or this was something to worry about.) Thanks!
start a new buttonhole as soon as possible
Do not use this site again
I would suggest - if there is room for you to ladder - that you ladder, well away from the troublesome site, while ongoing AB’s attempt to settle the infection down, remembering that this can take some time.
Remember a tract is, in essence, a scar tissue tract and that antibiotics may not enter scar tissue easily. Importantly, do not needle near the damaged part of the fistula. Have your nephrologist or vascular surgeon advise you if an surgical ‘excision’ may be needed.
Thanks Stuart and Dr. Agar, I started off on a new buttonhole site as soon as the infection was detected. I did not move to sharp needles. The infection looks like it is finally on its way out. I am now on maintenance oral antibiotics.
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to keep from having any more infections google "a kinder gentler methods for scab removal in buttonholes published Sept-Oct 201 Neurology nursing journal. In Canada and Belgium thy are still using this method and have reported 1` infection in the last 8 years, that is around 70,000 cannualtion with just one infection, this is the way to control infection plus the use of “Touch Cannualtion”
I did find the article but am unable to view the abstract or the full article. It just shows me the title and the authors. Is it a paid article?
look up a kinder gentler way to clean buttonhole site. we the USA and Austria and Europe have gone 54
,094 buttonhole cannualtion using this technique
Prevention of Infection in AV Fistula Buttonhole Access
Background of Problem or Opportunity for Improvement: For end-stage renal disease (ESRD) patients undergoing hemodialysis, infection of the arterio-venous access is the leading cause of access loss and the second leading cause of death in patients undergoing dialysis (Centers for Disease Control, 2011). Management of the arterio-venous access involves not only preparation of the site prior to cannulation, but evaluation and use of appropriate cannulation techniques. Selection of cannulation sites and determining the correct instruments to use are important aspects to consider.
Goals of the Project: To demonstrate that use of an exfoliating pad in combination with antimicrobial soap is an effective and safe method of cleaning and maintaining infection free buttonhole sites.
Approach or Interventions: An exfoliating pad with 1-2 drops of antimicrobial soap and water were used by the patient and/or staff preparing to cannulate buttonhole sites. Moderate pressure was utilized and the sites were scrubbed in a circular motion 9-12 times to remove dead skin, oil, and debrided the site of scab formation at the buttonhole site. The sites were then patted dry with clean paper towels and site disinfected with betadyne immediately prior to cannulation. After betadyne had dried, the cannulation needle sterile buttonhole pickers provided by the manufacturer were utilized to open the tunnel track and cannulate the access.
Outcomes: This practice was started in June 2009 until December of 2012 with only two patients and has proceeded with currently 24 patients over 42 months. To date there have been 27,000 cannulation with no observed or reported buttonhole site infections and the tunnel tracks have maintained their integrity.
Application in Clinical Practice: Infection control has been an ongoing problem since the implementation of buttonhole site cannulation and many dialysis centers have discontinued their use due to this issue. This project demonstrates that it is possible to maintain buttonhole sites and prevent infection with appropriate preparation and friction of the cannulation sites.
Place the exfoliating facial pads under hot water for 30 to 45 seconds> this is to make warm when applying to the patient’s skin. Then apply one to two drops of antibacterial soap.
Using you fingers with a glove on spread the soap around the pad to provide even distribution of the soap
Staff members or patient scrub the area in a circular motion using moderate pressure approximately 7-8 times.
Rinse soap and allow to dry are use a paper towel.
4 Examine the site to see if all the scab material around the buttonhole site is removed.
If there is scab material left in the buttonhole track remove by using the sterile needle that is provide in the needle kite
Place pad on top of dialysis machine to air dry during treatment use for 36 to 40 times and then replace.
The use of Betadine will be used as the stander for infection control
Repl
0 284 Jan 1
Prevention of Infection in AV Fistula Buttonhole Access
Background of Problem or Opportunity for Improvement: For end-stage renal disease (ESRD) patients undergoing hemodialysis, infection of the arterio-venous access is the leading cause of access loss and the second leading cause of death in patients undergoing dialysis (Centers for Disease Control, 2011). Management of the arterio-venous access involves not only preparation of the site prior to cannulation, but evaluation and use of appropriate cannulation techniques. Selection of cannulation sites and determining the correct instruments to use are important aspects to consider.
Goals of the Project: To demonstrate that use of an exfoliating pad in combination with antimicrobial soap is an effective and safe method of cleaning and maintaining infection free buttonhole sites.
Approach or Interventions: An exfoliating pad with 1-2 drops of antimicrobial soap and water were used by the patient and/or staff preparing to cannulate buttonhole sites. Moderate pressure was utilized and the sites were scrubbed in a circular motion 9-12 times to remove dead skin, oil, and debrided the site of scab formation at the buttonhole site. The sites were then patted dry with clean paper towels and site disinfected with betadyne immediately prior to cannulation. After betadyne had dried, the cannulation needle sterile buttonhole pickers provided by the manufacturer were utilized to open the tunnel track and cannulate the access.
Outcomes: This practice was started in June 2009 until December of 2012 with only two patients and has proceeded with currently 24 patients over 42 months. To date there have been 27,000 cannulation with no observed or reported buttonhole site infections and the tunnel tracks have maintained their integrity.
Application in Clinical Practice: Infection control has been an ongoing problem since the implementation of buttonhole site cannulation and many dialysis centers have discontinued their use due to this issue. This project demonstrates that it is possible to maintain buttonhole sites and prevent infection with appropriate preparation and friction of the cannulation sites.
Prevention of Infection in AV Fistula Buttonhole Access
Background of Problem or Opportunity for Improvement: For end-stage renal disease (ESRD) patients undergoing hemodialysis, infection of the arterio-venous access is the leading cause of access loss and the second leading cause of death in patients undergoing dialysis (Centers for Disease Control, 2011). Management of the arterio-venous access involves not only preparation of the site prior to cannulation, but evaluation and use of appropriate cannulation techniques. Selection of cannulation sites and determining the correct instruments to use are important aspects to consider.
Goals of the Project: To demonstrate that use of an exfoliating pad in combination with antimicrobial soap is an effective and safe method of cleaning and maintaining infection free buttonhole sites.
Approach or Interventions: An exfoliating pad with 1-2 drops of antimicrobial soap and water were used by the patient and/or staff preparing to cannulate buttonhole sites. Moderate pressure was utilized and the sites were scrubbed in a circular motion 9-12 times to remove dead skin, oil, and debrided the site of scab formation at the buttonhole site. The sites were then patted dry with clean paper towels and site disinfected with betadyne immediately prior to cannulation. After betadyne had dried, the cannulation needle sterile buttonhole pickers provided by the manufacturer were utilized to open the tunnel track and cannulate the access.
Outcomes: This practice was started in June 2009 until December of 2012 with only two patients and has proceeded with currently 24 patients over 42 months. To date there have been 27,000 cannulation with no observed or reported buttonhole site infections and the tunnel tracks have maintained their integrity.
Application in Clinical Practice: Infection control has been an ongoing problem since the implementation of buttonhole site cannulation and many dialysis centers have discontinued their use due to this issue. This project demonstrates that it is possible to maintain buttonhole sites and prevent infection with appropriate preparation and friction of the cannulation sites.
Prevention of Infection in AV Fistula Buttonhole Access
Background of Problem or Opportunity for Improvement: For end-stage renal disease (ESRD) patients undergoing hemodialysis, infection of the arterio-venous access is the leading cause of access loss and the second leading cause of death in patients undergoing dialysis (Centers for Disease Control, 2011). Management of the arterio-venous access involves not only preparation of the site prior to cannulation, but evaluation and use of appropriate cannulation techniques. Selection of cannulation sites and determining the correct instruments to use are important aspects to consider.
Goals of the Project: To demonstrate that use of an exfoliating pad in combination with antimicrobial soap is an effective and safe method of cleaning and maintaining infection free buttonhole sites.
Approach or Interventions: An exfoliating pad with 1-2 drops of antimicrobial soap and water were used by the patient and/or staff preparing to cannulate buttonhole sites. Moderate pressure was utilized and the sites were scrubbed in a circular motion 9-12 times to remove dead skin, oil, and debrided the site of scab formation at the buttonhole site. The sites were then patted dry with clean paper towels and site disinfected with betadyne immediately prior to cannulation. After betadyne had dried, the cannulation needle sterile buttonhole pickers provided by the manufacturer were utilized to open the tunnel track and cannulate the access.
Outcomes: This practice was started in June 2009 until December of 2012 with only two patients and has proceeded with currently 24 patients over 42 months. To date there have been 27,000 cannulation with no observed or reported buttonhole site infections and the tunnel tracks have maintained their integrity.
Application in Clinical Practice: Infection control has been an ongoing problem since the implementation of buttonhole site cannulation and many dialysis centers have discontinued their use due to this issue. This project demonstrates that it is possible to maintain buttonhole sites and prevent infection with appropriate preparation and friction of the cannulation sites.
Thanks so much for pasting the article here Dr. Mott. I will work on this.