Arterial cannulation issue

Hi Stuart,
For the past few runs, my arterial buttonhole has been almost closing up. Visually it looks like it’s disappearing plus the blunt has had to push through the fistula with force that I’ve never had before. Last night I had to use a sharp to go through but when I bled the line, it went very, very slowly. I wanted to see if there was resistance and when I connected a syringe, I was unable to push or pull any blood. I did notice that the 1" section immediately above the site was ballooned a bit. I pulled the sharp, held the site, and then tried again with a buttonhole. This time it worked fine and no ballooning.

Any input on what’s going on?

Thank you! I appreciate your help.

And are you self-cannulating, or is some one else doing it? What is the position of your arm–across your stomach, or straight out?

I self cannulate and I hold above the wings. This looks like it was an isolated incident and I guess I will never know why that happened.
Things have been as usual since - no problems.

Where are your buttonholes located: at your forearm, or upper arm?

upper right arm.

Ok, this is what I think happened, and the reason for this is, it has happened to me when I used to use the wings to cannulate. As you reached accros with the sharp needle, you bypassed the vessel and slid down the side. That is why you did not get any return. The MAIN PROBLEM WITH USING THE WINGS is that every time you use a sharp needle, you cut a new track. This is what I recommend and do in clinic and for some patients who do home dialysis and have upper arm fistulas. Use a TV tray you can get at Walmart. Place a pillow or cushion that is stiff on top of the tray and rest your forearm on it. Using “TOUCH CANNULATION,” place the base of your palm on your arm to cannulate. That way, every time it is the same. Look at the webinar “Touch Cannulation” on homedialysis .org. This has worked. Make sure you practice before you start .

I did get a return, however, when I bled the line it was very slow. When I used a syringe to check for resistance, I could not push or pull anything. When I cannulate, my arm is flat on top of my desk in the same position each time. The cannulation resistance I got with the blunt needle was the flap to the vein. I felt the same with the sharp but it did puncture through.

If I was on the side of the vessel, there would not be any return, which I did have. Thank you for you input. Since this seems to be an isolated incident, I am comfortable leaving it as an ‘unknown’. If it should happen again, I will be sure to post again.


How is your cannulation going?