Buttonhole migration

Has anyone had this experience, or is it only me?

Since starting with the buttonhole technique in March, I’ve had reasonably good success with it. I say “reasonably” because now and then, the needle just wouldn’t go in and I’ve had to switch to a sharp for a day or two. Not a big deal though.

My problem, however, is that, over time, I find it difficult to see the “hole” exactly. Many times, there isn’t much of a visible scab, just a very tiny slit. This is exacerbated because the betadine I have to use is dark, and so it makes the buttonhole all but invisible to find exactly sometimes (I need to use betadine because the swabs irritate my skin and cause a rash). Over time, what happens is that I’m a little off, which gradually enlarges the entry site. This is what I mean by “migration”. After a few months of this, it’s gotten to the point where I’m never sure where to put the needle in anymore, because the scabbed area is larger than the actual hole, and I have to hunt around for the exact entry point where the dull needle will work.

I don’t know if how I’m explaining it will make sense, but I am wondering if this is a common experience.

Should be common, happens to me to…all I do is keep an eye in which button is closing too soon and before it does I use that slot for dialysis…

Sometimes it’s hard getting the needles in. rarely happens…mostly happens when you leave the tape on all day…what happens is the tight taping/bandage causes the holes to move…in order to correct that don’t keep the bandage on all day, remove it after 8 hours and then use bandaids…

Other tips include to use a tiny bit of Neosporin near the buttonhole after each treatment…

Thanks Gus.


Since I posted the first message in this thread, I’ve been able to reestablish the exact buttonhole entry sites by very closely examining the site with a magnifying glass before each treatment to help determine exactly where the hole is before going in. In that way, scabs from other near misses over the past weeks seem to have fallen and/or faded away.

So now, I’m back to having a very little scab exactly where the needle should go in. These scabs are still not really easy to remove though. My experience so far is that if a scab remains in the hole, the buttonhole needle will deflect off of it a bit and miss the site, thus expanding the whole and making it harder the next time. But it’s not like these scabs are right there on the surface waiting to be easily picked off. They tend to be in the actual hole, rather than on the surface. My instructions say not to pick at it, but most of the time, it’s the only way to remove it.


I’d go to the garage and get the wireless drill… :smiley: jokingly…

I get what you mean, especially for those patients who suffer carpal tunnel syndrome…like myself…

Scrubbing with soap and water helps to but the prolong scrubbing starts irritating the skin causing skin abrasions and redness…

I hope they come up with a new invention called “Super Needle” :stuck_out_tongue:

I have been using the button hole method for about 6 months and have not any major problems. I use a pair of stainless steel tweezers to remove the scabs. There is generally very little scab to remove. What I do is try to reopen the hole so I can get the tip of the needle in the hole.

Ounce the hole is open I place the tip of the needle in the hole then I slide the tip of the needle in and out until the whole needle slips into the hole.

when I started home hemo I was given a clear liquid antiseptic which name I don’t have handy but it seemed to be chlorine based. there was no irritation and the visibility was great.
that doesn’t mean I never had problems getting the needles in and I did have to use a sharp from time to time, but at least I could see where to insert the needle.

It’s alcohol gel, I use it to…well icky gooey stuff for sure… :stuck_out_tongue: …my fistula looks like a monster, people see it and they get freaking scared that that they wanna runaway and hide…the buttons are very visible after 6 months…am pretty much proud with my fistula that it doesn’t bother me using short sleeved shirts…one time my teacher in college told me to start wearing long sleeved shirts… :oops:

I think of mine as a badge of honour :slight_smile:

It’s big and ugly, but I don’t try to camouflage it at all. Mind you, it’s upper arm, so, it probably isn’t that obvious under even a short sleeve.


not alcohol gel and not sticky and gooey. its just a liquid that kinda smells like chlorine. my skin is very sensitive but it was never irritating and I never had an infection using it.
Betadine is not only tough to see through, it is very messy (especially if you spill any) and also sticky.
soon as I can I will report back on the chlorine based product I was using. compared with anything else I tried it was the best.

Gus writes:
…the buttons are very visible after 6 months…

Do those of you who do buttonhole technique find that the buttonholes are unnattractive and are very visable from the rest of your access?

The buttonholes themselves are the least obvious feature on my fistula. They just look like little vampire punctures like you see in movies.

Exactly, same here… we’re Hollywood movies stars! :stuck_out_tongue:

If someone asked what is that I’ll just say I’m a Vampire, hehe

Hi All,
My husband’s buttonholes are 2 small holes. In the last year I have only had to use a sharp once on one button hole to open it up.
We find that by using the emla cream it loosens up the scabs and I can pick them off with plastic tweezers (that are disinfected).
His button holes are in his upper left arm and he does not have any “badge of honor” areas as of yet.
It is really amazing he is very prod of his arm and the button holes and lets every one check the “thrill”. :lol:

Sounds like your husband is doing great with his buttonholes. Was interested to hear how you use EMLA. Thought I had heard other reports that EMLA should not be used with buttonhole, but apparently not. I would think pulling off scabs might be irritating although some have commented it is not. Do you find that for your husband, the EMLA helps with the scab removal?

while rearranging things I just found a bottle of the antiseptic solution I used for buttonholing, not a gel but a clear liquid.
the brand name of the product is ExSept first aid antiseptic which is “electrolytically produced sodium hypochlorite 1,100 ppm (available chlorine)”. a very similar product is made by others.
my skin is very sensitive but I never had any problems with this and you can see through it, unlike betadine.

He puts the emla on about 1 hour before we canulate. I make sure that I smush it on the two holes and then put 2 x 2’s over with paper tape.
Not only does the emla help with pain it also softens the sites. Most nights I just take off the 2 x 2’s and the holes are ready to canulate. If by chance “he doesn’t smash it”, it loosens up the “plugs” enough that a pair of plastic tweezers just grams the plug and it comes out easy.
We also use something new that I put on the needle to help it slide right in.
I actually found it on the webb. The center ordered it (it is in the trial stages) but work really well. I will look at the name of it tonight and let you know.

Was going to begin a new post about this but found this one so interesting I thought it should surface again.
Have you found that after you go around telling people how good things are going something not so good seems to happen? Weird!
After having a couple of fairly stress free months with my first buttonholes suddenly my venous one has changed direction slightly. I don’t think it is the scab site migrating so much as the fistula going on a little trip upwards and sideways.Completely missed the venous the other night (had a slight flow initially)and ended up losing the blood in the lines because I wasn’t thinking quick enough.
Last night it happened again, but I tried again with another blunt after examining the site again and found the little blighter of a vein had actually taken this little trip in a new direction. Fortunately the scar tunnel was just big enough to do this little side trip but it was a bit of a shock to have those misses! Have yet to use a sharp on these but who knows what is next?
Have others had this problem with their buttonholes? :roll:

Oh yes, very common here…they actually move!! :x

All I do is move to… :slight_smile:

Use some alcohol swabs to wet the tunnels of the buttonhole…it helps finding the locations easier…

LOL, yes, it happens every time. As soon as you tell someone things are going well, the gods punish you for your overconfidence :slight_smile: