Buttonhole scab

Does anyone else have a bit of trouble removing the inner portion of the buttonhole scabs? The outside part comes off easily, but can’t get the inner piece out sometimes, and the needle doesn’t go in quite so smoothly, as it has to press through that deep scab.

You should never dig for the scab. If you get little surface scab off, you should be able to put your blunt needle in, maybe with a little help from twirling it to punch through. If you dig for it, you draw blood, and you generally chew up the sides of the buttonhole a bit. Sometimes I can’t even get a surface scab, because when I removed the gauze earlier in the day, it pulled it out because it was stuck to it. In that case, I just make sure I’ve broken the surface with the needle used to remove the scab. This is just something we have to do the best we can with, but without digging for the scab.

… at least, that’s the way I do it. Others may have other ideas.


i’ve found that before ever trying to pick at the scabs, if you let a wet gauze soak on the scab for a few min it softens it and makes it easier to get off.

Sounds like a good idea. You can also soften it by putting hand cream on it a couple of hours before. I found that Vaseline Intensive Care (unscented) worked well. However, after some experimentation with “softening” the scab, I decided that not softening it works better. I find it easier to take off in one shot if it’s dry. It pulls off completely, whereas when I softened it, the syringe needle tended to just dig into it.

More recently, my program decided that home patients are to put a dab of Povidone Iodine ointment on the gauze for holding the sites after. This helps prevent skin infections at the site, but I find it also softens the scab more than any other method I’ve tried. In fact, it’s so good at it that I make it a point to wash the Povidone off after I take the tape off so that the scabs can dry harder.


Here’s a 1 page fact sheet from the Northwest Renal Network on buttonhole that includes removal of scabs:

Also, there’s more on buttonholing on this site at:

I tend to get deep scabs too and it can take forever to get them off. Using a blunt needle to pick them can sometimes be quite a task. I have found sometimes if I have showered right before Im going to cannulate, the scabs have usually come off themselves, which makes it easier.

You use a blunt needle to pick off your buttonhole scabs? Here we use the sharp syringe needles. We fill 4 x 20ml syringes with 15 ml of saline, and then we use two of them to pre-flush the dialysis needles. We use the two syringe needles we took off these syringes to remove the scabs with.

Try soaking your scabs with alcholol prior to removing them. Doing so will soften them…

Another tip is after removing them and you have a hard time finding buttonhole canal use an alcohol swab at least 1-4 times so that it helps clear the pathway, after each swab try once …

You guys are nuts, I have a great blue plastic tweezers that I store in alcohol that grabs and removes the scabs in a second, no fiddling, sofening, creams, picking, etc., come on, get some tweezers!!


Oh my gawd, we couldn’t really be some nuts? :? …I’ve tried tweezers already and didn’t quite work okay with this carpal-tunnel I have… :frowning: …perhaps I need some giant tweezers… :lol:

Oh my gawd, we couldn’t really be some nuts?

Cashews I believe :lol: !! The ones I have are pretty big, maybe about 6" must be easier than trying with needles.


“Cathy S”
Oh my gawd, we couldn’t really be some nuts?

Cashews I believe :lol: !! The ones I have are pretty big, maybe about 6" must be easier than trying with needles.

Cashews, hehe… :lol:

What brand are you using? Where did you buy yours?

I got mine from my unit, have your nurse call Joanna in San Jose and see where she got it, it really is a good one.

P.S. We have to be nuts since we can’t eat many!!


Hey Gus
Maybe you need some of these burger tongs!

We use blunt drawing up needles, because they cause far less traumatic to the buttonhole site.

I use tweezers sometimes too, if the scab is pesky. Wiping the alcowipe over it a few times helps too.

Very funny Beachy, :lol:

But I’ll let you keep those for the kitchen, Cathy already gave me some some nice ones… :slight_smile: