Buttonhole site closes up


From time to time one of my BH sites closes up. Is it correct practice to go in with a sharp when this happens to open it back up again? I do know that sometimes the site seems like it is closed at first, because my angle is just a little off. But I have had some days that no matter how hard I try, I can not find the angle, and feel very sure it has closed up.

Jane, did you receive my reply?

No, I have not.

Hi Jane,

Sorry you didn’t receive my other message. Before I can answer your question, I need to know the answers to a few questions:
– How deep is your access (in mm.)?
– Where is it located?
– Which type of dialysis do you do, and how often?
– How much weight do you gain between treatments?

In general, yes, it is okay to use a sharp to help open up a Buttonhole that is hard to cannulate, IF you use “Touch Cannulation,” which I covered in one of the webinars. You can find those recordings on the home page (http://www.homedialysis.org). Touch Cannulation means holding the tubing behind the needle, rather than the needle or “wings” themselves. This process guides even a sharp needle into the Buttonhole without damaging it.

My access is an upper arm AVF, right at the top. nocturnal 6x. 1.0 average. What is it about touch cannulation that guides needles into the BH without damaging it? I am glad it is correct practice to use a sharp when sites close up as I read where some have said that using a sharp can slice into the side of the tunnel so should not be used. And I read where one person said his sites never close up. I will check out your videos the first chance I get.