Button holes

I am not on home hemo because it is not available in my area. I decided to go with the button hole techniqe for cannulization of my upper arm fisula. My problem is that after six sticks in a row the nurse tries blunt needles and has difficulty in finding the vessel. I seem to heal very quickly inbetween runs.
Does anyone have any ideas?

Are you in training to do home dialysis? Is the same nurse cannulating your access every time or are different nurses cannulating you? Have you asked the nurse if you can try cannulating yourself? You will be more likely to be able to find the track yourself because 1) you’ll be more likely to put the needle in at the same angle every time and 2) you’ll start to feel landmarks to let you know that you’re in the right place. Plus if you ever have to start a new buttonhole, you’ll be able to do it without a nurse’s help.

Afterthought: Sorry, I didn’t notice that you said that there wasn’t a home training clinic in your area. Did you check on our Find a Center database? With home dialysis you don’t have to go to a clinic as often. You could have a clinic as far away as you’d be willing to drive once or twice a month.

From what we’ve learned from several patients we know who have buttonholes, even months after establishing the tunnels on some days it seems like the tunnel has closed up, but this is not the problem at all. It is exactly like peirced errings. You may be poking the needle into tissue right next to the tunnel thinking it is the opening, but it it not. By staying calm and continuing to gently search for the opening with the needle it will go right in. Also, there is a flap of tissue that may get in the way so by nudging the needle gentlly in different directions you will be able to find the opening. Also, since your bhs are new you may need a few more times with the sharps, but after that they will be ready for sure. Whoever is doing the needles should not poke too hard. If a nurse is doing it instead of the patient she would be shooting in the dark even more than the patient would. So, it is best when the patient does it. but if the nurse is patient and skilled she will find the tunnel.

Are you a diabetic? If so, generally it can take up to twelve consecutive needle insertions with diabetic patients before the track is fully developed. Also, some people find they must switch periodically from using blunt buttonhole needles to sharps to ‘reopen’ the track. (I have had to do this myself) When you notice the needle is not moving smoothly through & into the track, do not force it as this can cause additional problems with pseudo aneurysms making the buttonhole unusable. (I’ve also experienced this) Give yourself some time to develop your tracks and technique…the ‘better safe than sorry’ adage seems to apply to all things related to dialysis.

It can be harder to develop, maintain and then find the tracks when it’s an upper arm fistula. There is a lot of tissue up there to go through, and it tends to shift and get in the way. I think it’s harder if you don’t do it yourself, because I always found that my ability to feel the blunt needle going in was essential. Also extremely important to always keep both your upper arm, your forearm and even your hand at exactly the same angles and position each and every time, or else things won’t line up. It nominally takes 6 days to start a new buttonhole, but it’s not like it’s perfect. It might take a few more sharp needles, and even then, it can take a sharp needle to go in every once in a while. But do pay attention to arm/hand position, and also ensure that your tourniquet is always at the same tension - and not too tight.

Now transplanted
A year and a half on daily nocturnal hemo
2-1/2 years on in-centre hemo