Buttonhole Issues

Lately, I have been having issues with my buttonholes. Since I’ve Started NxStage, I’ve been gaining weight. Approx 12 lbs so far. My buttonhole is in my upper arm, therefore, there is more muscle mass and fat in the area.
I’m afraid with the weight gain, it is becoming harder to stick me. It sometimes takes as many as 10 neede sticks until the vein is finally found and hit. The arterial seems to be the bigger problem. This is very frustrating and painful. I also think my vein may have moved a bit since the buttonhole was formed.

I have reported this to my nurses/Dr. They are thinking of creating a whole new set of buttonholes, but im not sure this will fix the issue as I will continue to gain weight and may run into the same problem again.

Has anyone else had issues with accessing the vein with weight gain?
Does anyone have any input or suggestions on what to do to find the vein. Any info is greatly appreciated.

Is your fistula mature? How many years do you have with it? Can you you see it bulged above the skin? You know, like ballooning?..

Guest asked about buttonholes.
My husband was having problems with the first set.
We had a fistulagram done of the whole arm and found out that there
was a problem at the elbow not in the fistula.
His fistula is in his upper left arm.
Hope this helps.

I think a fistulagram is a terrific idea.

You say you’ve gained 12 pounds. How long have you been on NxStage? Did you need to gain weight? Are you sure that you’re gaining good body weight or is it possible that you have swelling in your tissues in your arm that is making it harder to find the fistula through the tissue? How’s your blood pressure, do you feel short of breath, and do you have edema?

If the 12 pounds is not fluid weight, lifting of the dietary and fluid restriction and better dialysis may have made your appetite so much better that you’ve gained the weight. If you didn’t need to gain that much weight, talk with the dietitian about the foods you’re eating to make sure that you’re not eating foods with empty calories? You might also want to do more physical activity to keep your weight at a healthy level.

I have also gained weight since starting NxStage but I needed to. I did notice that I was snacking on the machine a little too much–400 calories each day of empty calories just because I was bored. I have cut that out now. This did not effect my button holes at all. My button holes are well over 2 years old.


There is a man in our program who has filled us in quite a bit. He has not gained a lot of wgt. but has had trouble with his buttonholes. He said he finally figured out that the only problem was that he was going in at the wrong angle. He said he has had days where, just like you, he has tried repeatedly to get in and it would begin to get painful as he poked around. But then, suddenly, the needle would go straight in. He’s had problems with both his sites and explained it was nothing but the angle. So, I wouldn’t form two more buttonhole tunnels until you work with the existing tunnels a little longer to rule out the problem. Don’t poke around too hard and just gently go in different directions until you find the correct angles of the tunnels, similar to how one finds the hole for a pierced erring. You may just be off slightly and that is the only problem.

I recently received a kidney transplant, but I was on daily nocturnal home hemo with buttonholes for a year and a half. I’m well familiar with the original poster’s problem. I gained weight and muscle mass after starting the daily nocturnal, which was preceded by 2-1/2 years in-centre. About a year into the buttonholes, one of them had shifted to the point where the established track through the heavier tissue in the big upper arm fistula was edging more and more towards the side of the vein, and eventually it was missing it completely. The only solution was to start a new buttonhole in a better spot. This only took a week (which I did as short daily in the home hemo unit), and then I was back in business.

From what they told me, the same thing happened to a number of patients since the start of the home hemo program. Upper arm fistulas are big, but there’s a lot of loosy goosy fat and muscle tissue up there.


I would have to admit gaining some weight here as well, but now that we’re at home the kitchen is nearby and we start getting that habit of eating all these little snacks while dialyzing! :lol:

However, I have not encountered any problems getting buttonholes in…but certainly I started cutting the snacks now!! :roll: