I just want to share my experience using the BUTTON HOLE techinque. I have been on diaysis for almost 18 years. I am just starting my second month on home hemo using the Aksys machine. Prior to that I was at a hospital unit. I have had the same fistual for 18 years… Yes, 18 and for over 12 years I had always insisted that the nurses use the same hole to put my needles in. Mostly because my fistual never got very big and I knew if they used the same hole they would not blow my vein. So, I have been using the button hole technique for 12 years without an ounce of trouble. I have developed a “track” in which my needle threads right in. There is a slight dimple were the needle goes in but it is never sore. Nor does it ever give me trouble when it comes to stopping the bleeding after taking out my needles. I generally stop within 2 to 3 minutes.
I guess you could say, that i’m a big fan of the button hole technique!
I’m glad I started doing it years ago because it sure made needling myself 100% easier.
Deena 
Deena, I share your opinion of the buttonhole technique. Do you use sharp needles? How many different staff needled you while you were in center? How did you explain the correct path to use? Cheers,
Bill
Hey Bill,
I have always used Sharp needles. They tried to get me to use the blunt tip while I did my training for my Aksys machine but, I had trouble trying to clamp the needle. I decided that for me it was best to stick with the Sharps.
Over the years I generally had a different nurse for every treatment. It wasn’t until the last six months at my old unit that I usually had one of two Tech’s work with me. Then, I started to needle myself for the last 4 of those months.
As for how I directed them for placement… I had a actually memorized just what I wanted them to do. It got to the point that they all knew what I was going to tell them. I was a very strong and opinionated patient. I had even heard nurse telling new nurses or tech’s that they were to do what ever I wanted them to do. No questions asked!
I’ve always felt that if your a patient, then you should be involved as much as possible. After all, it’s YOUR life and no one elses. More patients should take on that attitude. I think they be much better off.
Take care,
Deena
Hey Deena,
Did you know you were doing the buttonhole technique when you first started with it? Have you had the same 2 tunnels all this time? I’ve read that it is better to selfstick when doing the bh, but from what you said, it worked fine having the techs insert the needles. Why did you decide to start selfsticking?
Jane, Way back when I started doing the button hole I had no idea there was such a thing. I just felt more confident that the nurses would not blow my vein using the same holes. I was actually setting myself up for the future and never knew it! :lol:
I have had the same to tunnels now for about 12 years.
The reason I decided to self stick was because of 2 things. For 16 1/2 years my old unit had either RN’s or LPN’s needling us. Then a new head nurse came and she decided to start a Tech Program. The Tech’s were just everyday people off the street. Young and old and most without an once of medical back ground. That made me think that if anyone could basically learn how to needle, then I could too! Sure enough, I tried one day and from then on did it myself.
The second reason was I really needed a change in my life and I heard about a home dialysis program starting up not far from where I lived.
–Deena
Yours is certainly a very interesting experience, Deena. It goes to show that when dealing with a chronic illness regimen, instinct can take over and one can discover better ways of handling things. Has the home program, as compared to in-center dialysis, provided the change you were looking for?
Has anyone who uses the BH tech. encountered any problems? I read once where a man was using the technique and one of his tunnels stopped functioning. Would like to know the things that can go wrong. Does anyone know of long term statistics, because so few professionals seem to have info on BH, no ample stuides.
hi, people, i have been on hemo for 5 yr’s and PD for 5 yrs’, ( hemo now), aywy, the nurses in my unit want to start the BH technique after 5 yrs and into a very distended vein, . there is so much scar tissue that it doesnt hurt that much anywhere aywy, but the BH is new to these ppl, i guess my question might be after all this time (5 yrs in different spots on my left forearm, they say the BH is a better technique bcz of less pain , better seals at the needle site and doesnt bleed as much, i have great flow anywhere in the fistula and wonder why they chose this BH now, i dont needle myself but so far the bh seems to work fine…i just dont get why tehy would after all these years of different spots they chose now to do the BH method, I need opinions plz, timshaw40@yahoo.com
Hi Deena
That’s fantastic that they have been working for you so long with sharps. I know of a women that has been on home dialysis for about the same length of time using sharps in (or around )the same 2 spots without much trouble. She just insisted that that was the way she was going to do it and did!
One hospital out here has actually stopped patients doing buttonholes because they had high infection rates. The nurse said that one patients was using their fingernail to pick the scabs off!!! Yikes!!! Some people…I mean really!
Buttonholes, I love 'em. With a small fistula they are the best way to go, the stress of self cannulating goes from through the roof to a breeze. (touch wood)
Cheers
Hi Tim, one reason (apart from too much scar tissue building up) may be a cost issue. If they have been using local anaesthetic on you to get the sharps in and also the extra time that takes? Although you would wonder “if it ain’t broke, don’t fix it”
Cheers
Hi Tim. You’re certainly welcome to be part of the “if it ain’t broke, don’t fix it” school of fistula cannulation. There are no controlled studies of Buttonhole vs. the rope ladder technique. But folks who use the Buttonhole technique really seem to strongly prefer it, so centers are starting to offer it to everyone with a fistula. The thinking is that the Buttonhole technique is less likely to cause aneurysms, infiltrations, and other problems that might eventually lead to the need for fistula repairs. And, even if that isn’t the case, it seems to cause less pain and faster cannulation.
It’s ALWAYS best to cannulate yourself with the Buttonhole technique, however. It’s best to start your own Buttonholes, too. Some of the only problems I’ve heard with it is infection from not using sterile technique to remove the scab–and bleeding around the needle site because too many different people are cannulating a Buttonhole–each using a slightly different angle.
Just found your blog. I’m seriously considering Buttonhole so that I can do Home Hemo. I have a finicky fistula…venus only about 1/2" of sticking area and arterial VERY large and distended. Does anyone have experience with this?
I’m concerned about any problems associated with BH and have heard it becomes like inserting an earring! Can this really be true? To a true needle-phobic person this is music.
de
De, I’m sure folks who actually use the Buttonhole technique will reply to you. Being needle phobic myself, what I’ve noticed is that it’s easy for me to watch the video we have on this site of Bill P. using his Buttonholes–http://www.homedialysis.org/resources/links/BillMovie1.flv--because the needles are blunt. You may want to check out our articles on needle fear and self-cannulation, if you haven’t already:
– http://www.homedialysis.org/resources/tom/200605/
– http://www.homedialysis.org/resources/tom/200508/
When you say your fistula arterial is VERY large and distended, you do need to be sure this is not an an area of aneurysm (ballooning out of the vessel wall). If so, it’s not safe to put dialysis needles there, and a repair may be needed.
[QUOTE=Unregistered;15087]Just found your blog. I’m seriously considering Buttonhole so that I can do Home Hemo. I have a finicky fistula…venus only about 1/2" of sticking area and arterial VERY large and distended. Does anyone have experience with this?
I’m concerned about any problems associated with BH and have heard it becomes like inserting an earring! Can this really be true? To a true needle-phobic person this is music.
de[/QUOTE]
Hi De
I too only have a very short venous area and have found buttonholing a godsend. It is painless and easy as long as you stay on the track you make. I was going off track now and then until I found a freckle I line up with now and it works beautifully. I hated using sharps, getting sore and bruised and stuffing around with local needles as well . Stress levels have dropped from 99% to 10%
There are lots of posts on here about buttonholing and they were a great help to me. People have different ways of scab removal and after reading of Bear’s infection in his fistula I am always vigilant with my scab removal and care.
I use a new 19g sharp to lift the scab from each buttonhole and have a pair of stainless steel tweezers that I boil for 10 mins and soak in antiseptic, for if I need to pull the scab off. But others do different things.
Hope buttonholes work for you
Cheers
Mel
I think that problems like stenosis and clotting can occur with either technique. I had a stenosis treated while on buttonholes.
Pseudo-aneurysms will eventually develop. The difference is that if this happens with the buttonhole technique, it will likely be only at the buttonhole site itself. With the stepladder technique, it will happen over the entire area covered by the stepladdering. This can render unusable a lot of real estate on your fistula vein - and it can dramatically shorten the useful life of your fistula. Eventually, you can’t put needles in those anymore.
I had two big pseudo-aneurysms already from the 2-1/2 years at the dialysis centre before I switched to home hemo and buttonholes. Like I said in another post, I still have my fistula, and I still have the 2 big aneurysms. But where the 3 buttonholes were, I have only a tiny bump of scar tissue over each one.
Buttonhole didn’t work for me because my fistula rolled too much so it was impossible to establish a buttonhole pathway at the same angle even by the same cannulator. But I would still recommend buttonhole especially for anyone with limited cannulation space. Especially if it is big enough to handle it I would say go for it! Just make sure you have the SAME cannulator for at LEAST the first 6 times … even longer if you can! Use numbing cream like Emla cream so you don’t have an extra stick yet still have less pain. Even though with buttonhole you end up with less pain in the long run I have heard. If I didn’t get my transplant I would have attempted buttonhole once again.
My experience was that eventually there is little pain even with the usual stepladder method. I guess it’s a combination of just getting used to it and also gradual deadening of the nerves in there. I used Emla the first year, but I gave it up after that. Just went cold turkey, and I never had any problems.
There is little pain with an established buttonhole - none in fact, since you aren’t really puncturing anything that can feel pain. You don’t really want to use Emla though, because feeling pain is kind of part of the correction process. If you feel any, you know you’re not going in right, or that something is going on (the veins can migrate a bit over time). It’s not that hard to miss the exact angle on any given night. It’s not that much a matter of pain, but you do need to be able to feel what’s going on when you buttonhole. I guess it might be possible, but I wouldn’t use Emla myself.
But to be honest, none of that is the main reason for the buttonholes. If it helps the fistula last longer, that’s a nice, desirable side effect. Same with the minimizing of pain. It’s really more for safety reasons, especially when we’re talking about nocturnal hemo. You don’t really want to have to worry about an extremely sharp needle tip working its way through the other side of the vein during a treatment as you move your arm. The blunt needles can’t do that. They aren’t sharp enough to go through (it would take a heck of a lot of force). I would even go so far as to say that it would be impossible to do nocturnal safely without buttonholes, unless someone we’re to strap you down securely onto the bed like Frankenstein’s monster.
If I ever have to be on dialysis in-centre again, I would absolutely, positively want to buttonhole the needles myself, if only to impress the other dialysis patients
[quote=Pierre;15132]
If I ever have to be on dialysis in-centre again, I would absolutely, positively want to buttonhole the needles myself, if only to impress the other dialysis patients :-)[/quote]
When I was trying to have buttonholes established I would have the Emla cream for less than the suggeted time so that I did still feel but wasn’t as bad as without as they were having problems with hitting a nerve a lot or infiltrating my fistula. But I did have my fistula cannulated without Emla cream near the end when I didn’t have any with me and had to do HD at the hospital after my transplant. Wasn’t so bad … the area does deaden.
I was impressed by this man in my unit who would do his own buttonholes and why I got interested in doing it myself. He was the same man who had his transplant around the same time I did this time around. He is an inspiration to me. His name is Calvin. He is very strong to me and seeing him do it as he was in the very next chair to me in my unit, I had been trying to get up the courage to cannualte myself. I find it really scary though since I have a hard enough time even now giving myself my Epo injection subQ!
I was told I would never be able to because my fistula is so wiggly that even the same cannulator could not establish a path as the angle would always be different no matter what. But if I didn’t get the transplant when I did I was going to try again in the new year as my fistula got a little bigger and less wiggly with time.
I feel that buttonhole would benefit me as they had limited cannulation spots and were basically cannulating me in the same areas anyway … which made me worry about my fistula not lasting as long as it could!
[B]I’m a BIG fan too! The buttonhole has really saved my fistula and must say that I think every in-center clinic should use them too…
If possible, share us some pics or videos of you da “Buttonhole”…hehehe
Check some videos from a few of us[/B]
Home Dialysis Videos
Thanks for sharing,
Merry Christmas!
[quote=Deena;688]I just want to share my experience using the BUTTON HOLE techinque. I have been on diaysis for almost 18 years. I am just starting my second month on home hemo using the Aksys machine. Prior to that I was at a hospital unit. I have had the same fistual for 18 years… Yes, 18 and for over 12 years I had always insisted that the nurses use the same hole to put my needles in. Mostly because my fistual never got very big and I knew if they used the same hole they would not blow my vein. So, I have been using the button hole technique for 12 years without an ounce of trouble. I have developed a “track” in which my needle threads right in. There is a slight dimple were the needle goes in but it is never sore. Nor does it ever give me trouble when it comes to stopping the bleeding after taking out my needles. I generally stop within 2 to 3 minutes.
I guess you could say, that i’m a big fan of the button hole technique!
I’m glad I started doing it years ago because it sure made needling myself 100% easier.
Deena :)[/quote]
Really great videos Gus! I hope to see even MORE!