Buttonhole method

I am going to try the buttonhole method. Any hints…?


I am only fairly new to this too and read all I could find initially.My home training nurse visited once and picked two spots and then it was up to me. My advice is PERSISTENCE pays off! I found putting the sharps in for the first 6-8 times quite challenging at times as it tended to hurt as it scraped the sides of the tunnel that was forming. You do need to try and be as exact as you can but it is not always easy and can still hurt. However it is not rocket science and you do get a feel for it.
Now after several weeks of having progressed to using blunts the actual stress of needling has gone from 90% to around 10% ! It has made all the difference to how relaxed I am as I am setting up.
It is great to not have to think about which spot on your arm to use tonight and whether you are going to miss or not as the blunts will only go in the right place. So my advice is Go for it.
Good luck.

Learn more about the buttonhole technique by visiting http://www.homedialysis.org/v1/types/buttonhole.shtml.

Something I have wondered --when establishing the tunnels, are the same gage sharps one normally uses the gage that will be used? And, when being trained in-center, does a staff member usually do the initial sticking to form the tunnels or does the patient do it? I realize it should be the same person everytime. I have heard of situations where the nurse/tech does not get the right angle, scarping the side of the tunnel and the patient is in pain. So, is it better if the patient is trained to do the sticks?

I’ve wondered about that also. Seems risky to have to train on a fistula you should be guarding with your life because it is your lifeline. Maybe they’ll have Hubby stick his other arm a time or two for practice before he attempts the fistula the first time? Maybe he could use my arm for training first? :shock: Techs sometimes have a hard time hitting mine so if he can get mine the fistula should be easy. :lol:

We need the voices of experience here. :slight_smile:

Same size needles are used for both. As I said in first post my nurse chose spots, did first insertion, I watched carefully, then it was mine to “play with”. Obviously only you know when it hurts and are best to get the things in there on the right track, if that is what you want to do.

Needling has now gone from about 90% of the stress to less than 10% ! My whole outlook on dialysis has changed because of buttonholing. No more worrying about where to go in and will I miss!

Cheers 8)

Thanks guys for your advice…I’ll let you know how it goes.


Something I am wondering-- if a patient starts off a new access using BH method, never having done conventional ladder method, would the access still become large and ropey looking? Seems at leaste there would be less scarring.

So far so good for me, but it is only early days. The rest of my fistula is not to be seen yet, but I am sure it will build up when the time comes for me to use it. Have noticed since I have been back at gym (doing light weights) it has definitely become noticeable down near site of surgery and where the buttonholes are an inch or more above this.
As we spend most of the year here in short sleeved shirts and I perform in a festival drumming band, ropey fistula or not, the world will have to get used to it!
Cheers 8)

It will get larger eventually. The only thing you won’t get with buttonholes is the progressing scarring from stepladdering, which can eventually develop into an aneurysm - but how fast that happens depends on how much actual length of fistula they can put needles into. Aneurysms can sometimes be repaired though.

You have to realize that a fistula really needs months to develop (by develop, I mean the stretching out of the vein). In recent years, they seem to put them in very late, and then they start using them before they are really developed. The thinking seems to be that using it for dialysis if you can will quickly develop it.

My fistula surgery was done 6 months before I started dialysis, and by that time, it was already nicely enlarged and very visible.


I was reading the article on establishing the buttonholes and it said after approximately 6 cannulations using a sharp needle to create a scar tissue tunnel track the dull needles could be used. Did you find 6 cannulations enough before you started using the dull needles? Beachy, did you start right out using a fistula or did you have a catheter first?

Marty, 6 was enough for one of my buttonholes, but the others took more. If it didn’t go in easily I just switched to a sharp. I used extra needles, but I now have very good buttonholes.


Hi Marty
5 or 6 goes with a sharp was more than enough for me.You just sense when you have had enough of those critters.
Yes, I started out with the fistula just over 8 months ago now. First few months I tried step laddering with varied degrees of success. Even though I exercise regularly and scans all look fine, I can only really see and feel it confidently for the first 4 inches up from wrist yet so buttonholing was a godsend.
As Pierre or was it Gus, said, you just have 2 little vampire bites! I find gently rotating slightly back and forth as I go in works a treat. Haven’t needed to use a sharp to remake tunnel yet…

6 sharp sticks in the same place for each buttonhole. On day 7 we started with the buttonhole needles. After that, like Cathy, I occasionally had to use a sharp when the dull needle wouldn’t go in. That’s to be expected and it’s not a big deal. You don’t want to go much more than 6 days before switching to the dull needles, because doing it with sharps any longer will make the buttonhole tunnel too big and result in bleeding. Sharps go through even if you are a little off on the angle of insertion, but buttonhole needles don’t.

Thanks for the answers. My time to start using the fistula is about 3 weeks away. Needless to say the anxiety of it has already hit me. I was questioning the time to get a feel for how long to rent a motel room. Probably if I reserve a room for 2 weeks, I’ll be covered.

Hi Marty,
Just thought I would let you know I started Ralph’s buttonholes about 2 weeks ago. We did them in center 2 times and than I took him home.
We kinda a did a no no, but it worked.
I would insert the sharps first and then clot off for a few minutes and than inserted the blunts.
It has been working great. I have been using blunts on him for about a week now.
I am going to put another 2 buttonholes in probably the first week of may so we can than have 2 sets alternating between them.
Please feel free to contact me any time. pc639@nycap.rr.com

Our nurses did our cannulation for us until we felt confident enough to do it.

I am going to put another 2 buttonholes in probably the first week of may so we can than have 2 sets alternating between them.

Does your clinic require you to have two sets of buttonholes? There are many people that only have one set and if that one fails, they develop another set at that time.

I was strongly encouraged to have two sets of buttonholes, I believe it is because they feel they will last longer if alternated. I also find that giving them the day rest gives them time to heal so that they are seldom sore.

home hemo 9/04

We used to be advised to have 2 sets but now we are told one set is better. For me to make two more sets I wouldnt be able to use my original venous button hole, as its quite close to the arterial. So it would have to be moved, so I would have to make 3 more holes.
I used to have 2 venous sites, but they healed over too much, so I couldnt get a blunt in. Im happy with only 2 sites. But if for some reason I cant cannulate one of them, I am confident enough to find another spot and use a sharp. I really dont like doing that, but if you want to go on the machine, then thats what you have to do. I have used several other sites on my arm, so if needed I just use one of the old sites.