My buttonholes close up fairly quickly. I had a bit of trouble when I used to have more than one set of holes which I rotated the usage. I now only have one set of holes, which is the latest recommendation. I usually have trouble with the arterial, used the be the venous, but they seem to each want to take turns in making it hard for me.
The most times Ive tried to cannulate using a blunt is 7. Other times have been 3-5. It usually works after a few goes. I did find a few times I was feeling pain with a difficult blunt cannulation, so all I did was injected more local and I was able to get the needle in. I think the feeling of pain causes you to resist advancing the cannula any further. That was in my case anyway.
I have had to use sharps in my buttonholes before, and I have also had to make a new site all together. There were a few times where it was either make a new site by yourself, or wait til the next day and go incentre to get a new site.
I do get a bit of pain using sharps, for obvious reasons. I do worry a bit whilst using sharps overnight but its just something that happens from time to time. I tape my needles up very well, so hopefully they dont move too much.
Amba wrote:
I now only have one set of holes, which is the latest recommendation.
The latest recommendation by whom?
Has anyone who has a problem with buttonhole tunnels closing up, thought of inserting buttonhole needles on your off day from tx? Wondered if this might prevent them from closing off so they will stay open for the next tx.
Gawd Heather, it’s hard enough doing it all when you have to! The last thing I want to do on my days off is go near a marauding cannula, I try to keep all thoughts of dialysis in the corner of my mind that only gets open when necessary on the on days. Putting cannulas in is not a pleasant pastime at the best of times and is not totally without the sensation of some degree of pain. :?
The head honchos of course!
God no!!! Why would anyone want to do that!! Its probly not aloud anyway, as it costs more money as you would be using double the supplies of cannulas and dressing packs and everything that goes with it. Its totally unecessary. If you are having trouble with them closing up then you need to speak to the nurses or doctor. This is why I have found it much easier just having one set of buttonholes. If one wont work (which is rare), I just use a sharp. If I dont want to put a sharp into the buttonhole, I just cannulate in a totally new spot that I am confident with.
I heard it is allowed, but the question is, is it a valid strategy. Why would this be done? Obviously, to keep the bhs from closing up, sort of like the way peirced ears must be kept open with errings in place. For some patients, the tunnels tend to close up on the off days. This may be just in the initial formation period or could carry on- I don’t know. I have heard some say it’s ok to go in with a sharp, but the same people, or others, say that sharps could damage the sides of the bh. So, I am trying to validate the facts on this.
What would be the reason for sticking some place else with a sharp instead of in the bh?
Sharps can be used in the buttonhole but there is risk of damaging it, so its not really favoured. If you do do it however, you need to make sure you are going in the exact same angle as you would with a blunt. My arterial buttonhole is a bit fiddly and takes a bit of manuvering to get it in, so I dont think using a sharp on it would be a good idea.
I dont know the correct answer really, I would probly ask before using a sharp in the buttonhole, considering it is fiddly to even get a blunt in. I am getting more experienced now so If Im really having trouble with the blunts I just persist and try at least a couple of times to get it in.
I guess its up to you if you want to cannulate on off days, but definitely get permission first, and be aware that you would be using more supplies than normal. I wouldnt of thought it would be necessary to do this. If they are healing in between well it probly means you need to use sharps for a bit longer so as to build up the scar tissue.
I find that the off-days are important to allow the buttonhole to heal a bit. It helps form a nice scab.
I’ve used a sharp in a buttonhole occasionally. There’s no problem doing that when necessary, except that for nocturnal while sleeping, it may not be the safest thing. I’ve done it though.
Pierre