Buttonhole Issues

Lately, I have been having problems with my buttonhole. At first, the needles went in without any problem - slid right in. Now I am having a difficult time with the needles. Now it takes several attempts to insert the needle in both arterial and venous. It sometimes takes 2-3 different needles to open up the track before it slides in.

Does anyone else have this problem or make a suggestion for me? Not only does it worry me, it drives me crazy with all the poking and prodding.

Is it feasable or recommended to go back in center and have them re-stick the buttonhole site with a sharp needle? :?:
Or should I have a new set of buttonholes establisthed?

Any info is greatly appreciated.

Many possibilities I have experienced myself. For example:

  1. I wasn’t paying attention to always positioning my arm including elbow bend and hand exactly the same way.

  2. Sometimes if you don’t really remove the scab, you can start deviating a little from the original entry hole, and it can make the needle go just enough off the established track to make it difficult. This can get worse and worse until you need to reopen the whole thing by using a sharp needle instead of a buttonhole that day.

  3. There have been a few times when nothing I did helped until I just resigned myself to using a sharp needle that night. But once I don’t then take the sharp out to try with a dull needle. I just dialyze with the sharp needle for that treatment, and then usually the buttonhole works Ok the next time. You have to be as sure as you can be that you are putting the sharp needle in exactly the right spot, the exact right angle, etc. as the buttonhole. I never needed to go in-centre to do this.

Good luck. Make sure you get the part of the scab which is where the needle goes, keeping in mind that the needle doesn’t go straight up and down, but rather at a shallow angle. Make sure you get the scab there, and make sure that when you put the needle in, it goes in right there, right under the skin, and not deeper.


Hey, check this thread out…it has been spoeken before…read it all. This is not new and have had that problem before…that thread I posted explians some reasons and what to do…


Is it feasable or recommended to go back in center and have them re-stick the buttonhole site with a sharp needle?

It doesn’t sound as if you have been trained to use sharp needles and to start your own buttonholes. You should be.

If you can be trusted to be independent in doing your home dialysis, your center should train you to put in your own needles–including sharp ones. That way, if you run into an issue with a buttonhole, you can use a sharp for a treatment or two or start a new buttonhole if you need to, without going in to the center.

Lately, we’ve been hearing about centers that only allow patients to use blunt needles on already-created buttonholes. I think this is unwise and shortsighted–especially when multiple different staff people are used to create the buttonholes.

thanks for the replies,

I dont put the needles in myself. My mother currently does this. It would be difficult for me to place my ow needles in because I am right handed and that is where they had to put my fistula. I imagine I could learn to stick myself.

As for the scabs, I do believe im taking all the scabbing off. Im not doing anything different from when I first began and had no problems then. It just seems as time goes on, we have more difficultiy finding the vein. Eventually after many tries and needles, it does go in.

Gus, do you think that all I need is a sharp needle to open the track back up? Does it usually work after 1 stick, or will it require a few?
My mother is a bit leary on poking me with a sharp needlle for she has never been trained on doing so. It probably would have been a good idea if the center would have let her. The dialysys center is the one that started the buttonhole and gave it over to my mom after the tracks were started.

Perhaps is has to do with the positioning of the arm as Pierre stated.

do you think it is better to have the arm strait, or bent a little. My fistula is in my upper arm, so i usually bend it a little bit. Should I straiten it out?
Also, I think the tightness of the turnakit may have something to do with it.
How tight should the turnakit be and how close to the button holes should you have it when inserting the needles? Are there any holding techniques anyone uses near the buttonhole while they insert the needle?

It is just really frustrating that sometimes it takes a lot of digging and probing before we hit the veign to start treatment.

Thanks again everyone for your replies.

Mine is an upper arm too. One disadvantage of upper arm fistulas is that there’s a lot of muscle and fat tissue up there, and some of it is between you and the vein wall. So, if you don’t hold your arm exactly the same, you’re changing where everything is and the entry tunnel may not line up with the entry tunnel into the vein. I personally do it with my arm perfectly straight and the palm of my hand pointing up. That way, I know my position is exactly right. If you bend your elbow, it’s harder to bend it the same every time. But, you have to go with the way you started the buttonhole in the first place. BTW, over the past year and a half, I’ve had to give up on the dull needle and use a sharp maybe 10 tens altogether. Of course, you have to be very careful with sharps, because they are VERY sharp, and they will easily go clear through the other side of the vein. You don’t want that happening at home. Personally, I think that if you are consistently having trouble, you might need to have them review this at your training centre.

Yes ME, he says, before even reading the other responses. :smiley: ON a very regular basis! I have an upper arm fistula. Sometimes I even have to give up completely and skip to next day. Other times I’ve thrown up to 10 cannulas in the sharps bin, by the time I get on. :roll:
You must start cannulating yourself and you should carry some sharps @ home. Sometimes I am able to get on by using a sharp to start the entry off, then switching to a blunt, for overnight. If I have deferred to a daytime run, I may use sharps for the session. Usually next time on, the blunts are O.K. I may then go one or two weeks, before having trouble again. :roll:
Anyway, best of luck with it!!

Does you mum twist/twirl the cannulas back and forth gently to get them in the hole. I ALWAYS do this without exception and also occassionally pull it back out a fraction if I feel resistance and then twist it back and forth on the way in again.So far has worked for me.