Hi
From the reading on this board I understand that buttonhole is the way to go. In the center that I’m in they use stepladder only. I think because the same tech never has the same patient day after day. When I asked about this on 2/18/06 they told me that buttonhole was not a good way. Like I said from I’ve read on this board I take it most ,if not all would disagree that stepladder is the way go?
bobeleanor 
The buttonhole technique is only practical if you, the patient, are going to do it. You can’t expect staff, even if they know you or even if you get the same tech or nurse every treatment, to be able to use the buttonhole technique on you successfully. It takes enough finesse for the patient himself to do it.
Pierre
I know of an elderly patient who does BH in-center with staff doing the needles. He had the same nurse start the tunnels and now different ones do it. So, apparantly it can be done if staff will become educated and do it. It certainly would be better for the patients as there would be no more infiltrations and would prolong the life of their accesses.
To every rule there is an exception. I would say this is an exception. Look, buttonholes are a great idea, but they take a lot of continuing care and effort even for the patient. It’s hard to explain unless you’ve actually done it for a while. It’s not like there’s anything visible about that “tunnel”, plus it takes great care when removing the scab not to damage the entry point… and also when removing the needle. The dull needle is sharp enough to cut the skin around the buttonhole if you’re not careful. You can’t apply much pressure on the gauze when removing the needle.
When you say buttonhole, are they using sharp or dull needles on this man?
Pierre
The last I heard dull. In the units I have been in most staff are not skilled enough stickers, but could be with better training. It comes down to is managment going to throw them out on the floor with incomplete training and no review or train them well. Although some staff just aren’t gifted in cannulation most could do a far better job with better training. Most have never even heard of BH and even the better cannulators have never been trained in it. Corporations keep staff working out of their unit efficiency box. Why should patients suffer being stuck like pin cushions when there’s a better way? Do the BH needles cost more? There are better ways to do dialysis and this is one of them.
I can’t say I’ve ever had poor cannulation at my dialysis centre, but here, there are only registered nurses in dialysis centres. For us here, dialysis techs are what they call the machine technicians who maintain and fix the machines. I guess it’s a whole different situation in your system down there.
I don’t know. Just based on my own experience when I was dialyzing in-centre, they don’t mind patients putting their own needles in if the patient knows how, but I think that having nurses and/or techs carefully working with buttonholes in each and every patient would just be a time burden they can’t afford. They dialyze about 90 patients a day in my old dialysis centre, and that’s not counting the other 2 large centres and the satellite units. Adding 10 or so minutes of cannulation time for each patient might be too much. By my calculation, that would add up to a whopping 15 hours a day! Not exactly viable in a world where all work is counted as person-hours.
Pierre
[QUOTE=Pierre;4972]
I don’t know. Just based on my own experience when I was dialyzing in-centre, they don’t mind patients putting their own needles in if the patient knows how, but I think that having nurses and/or techs carefully working with buttonholes in each and every patient would just be a time burden they can’t afford. They dialyze about 90 patients a day in my old dialysis centre, and that’s not counting the other 2 large centres and the satellite units. Adding 10 or so minutes of cannulation time for each patient might be too much. By my calculation, that would add up to a whopping 15 hours a day! Not exactly viable in a world where all work is counted as person-hours.
Pierre[/QUOTE]
why does it take longer to use the buttonhole method? It took forever for me to get cannulated when I was on hemodialysis in center because I was a difficult stick. I cannot imagine it taking longer to use buttonholes. Can you elaborate on this?
Thanks,
[QUOTE=Unregistered;11723]why does it take longer to use the buttonhole method? It took forever for me to get cannulated when I was on hemodialysis in center because I was a difficult stick. I cannot imagine it taking longer to use buttonholes. Can you elaborate on this?
Thanks,[/QUOTE]
for some reason I was not logged in when I typed this reply. Just wanted to identify my post.
For those of you who haven’t checked out anything but the message boards on Home Dialysis Central, we have quite a bit of info on a variety of topics from our home page, including buttonholes and how to cannulate them on this site (under the 5 Types of Home Dialysis). Here’s the directly link:
http://www.homedialysis.org/v1/types/buttonhole.shtml
Although some nurses seem to think that they need to be the ones to establish the buttonholes, the best case scenario for buttonholes would save nurses’ time because the patient would be doing his/her own cannulation starting the first time. Recommendations are that a single cannulator get the buttonhole established. A patient can feel “landmarks” when inserting a dialysis needle into his/her fistula better than a nurse can. A patient is also more likely to insert the needle stick at the same angle whereas if there are several cannulators at a clinic it’s unlikely that any two will insert the needle at the same angle. According to the information we have, it takes about 6 times of cannulating a fistula using sharp needles to establish a buttonhole. After that the patient can use the dull buttonhole needles. Because he/she created a track like a pierced ear, there much less pain when cannulating a buttonhole. Also, from what I’ve gathered from reading patients’ postings, buttonholes bleed for less time after dialysis speeding up the process of finishing dialysis.
I really need to echo this for any kidney professionals who read these boards (and I know many do), because it is so important. Dialyzors need to be starting their buttonholes; not staff. Once folks dialyze at home, they need to be able to use sharps. This skill may be needed to start a new buttonhole, or establish a second set of buttonholes. People who can be trusted to dialyze at home need to also be trusted to cannulate their own accesses. It is their arm, after all. IMHO, the only exceptions to this are if the dialyzor can’t reach the access or can’t use the cannulating hand, in which case the home partner can start–and maintain–the buttonholes.
I have heard dialyzors say that buttonholes “don’t work, blood leaks around them,” and when I ask, invariably these (in-center) folks were being cannulated by multiple different staff. Even if it’s the same staff person, though, it’s much easier for a dialyzor to hit the same angle him or herself each time than for any staff person to do it. Please, please, please, encourage dialyzors to take on this role themselves.
Any access will last longest if only one person puts in the needles.