My husband and I just completed two weeks of home hemo training, and now he has to go back to the center because he could not get his needles in. He is a real trooper and really tried and tried each day, but finding the door to the vein is the problem. His buttonholes were established a few months ago, but at least one of the sites is very problematic. Can you give some suggestions on how to choose a site? His vein zig zags so there are only so many one inch straight shots, and then it seems to move and roll when he is trying to stick the needles. Should the needle go into the vein shortly after going through the skin? It seems that on his other ones you didn’t hit the vein hole until you were almost at the end of the one inch needles, and finding the vein hole is the problem. Any suggestions would be appreciated.
Hi rmtaylor. Before Stuart pops in with his answer, I wanted to ask WHO started your husband’s Buttonholes? If he started them himself, he shouldn’t have any trouble finding them again. But, what often happens in dialysis clinics (perhaps due to control issues among the nursing staff, fear of lawsuits, or some other reason) is that the staff insist on starting Buttonholes for people. The problem is, the angle that a nurse would use is almost certainly different than the one a self-cannulator would choose. This can make it very difficult to hit the mark, as it were.
Needle length can also be important–especially for a zigzaggy fistula. A shorter needle will give him more chances, and there’s really no need for it to be long.
My husband started his previous buttonholes. This morning in center one of the nurses started a new buttonhole for his arterial, which was the more problematic one. I told him from now on HE should put the needle in, not the nurse. I don’t know why but they use only one inch needles around here - even at the home hemo training.
Sorry you are have problems. No 1 ask for the 3/5 inch needle from Mede-systems this needle was designed just for shawwoll access and the ones with limited area to cannulate. No2 use "touch cannulation’ just Google this and the article will come up are watch the videos on this site to see it. Go to your vascular surgeon tell them what type of problems you are having and ask to have a ultrasound done that will show you how the fistula is working as well as the size. If you are having trouble cannulating the venous needle into the fistula after trying with the buttonhole needle and you cannot get it in pull the needle out. Use ‘touch cannulation’ the needle will slide down the tunnel track and all you have to do is push with little pressure and the needle will go in. use this method whenever you are trying to cannulated. Nurse will tell you never to use a sharp needle to cannulate a buttonhole track. i agree with them never use a sharp on the first try but after that if will not go down use the sharp you have already open the tunnel track up with the buttonhole needle. Ask the nurse why she is trying to start a new art site and let me know why. One other thing i need is what the deep of his access is. You find this out by cannulated how far the needle goes down before you see a flash back. One more thing as he is cannulating have him make a fist has hard as he can this will freeze the site and stable the vessel. Let me know what happens
Thanks for all the advice. The reason they are starting a new arterial buttonhole is because no one can ever find the vein hole on this one (they think it might be on the side of the vein) and it’s at a bad angle. His fistula is on his upper right arm and the arterial buttonhole started on the outside of the arm and went towards his body, which was a tough angle for him to stick. He did help choose this site, and he thought it would work because it was one place that had a full inch to work with. The nurse started a new arterial buttonhole a couple days ago and I told him to make sure he sticks that needle in himself and don’t let the nurse do it. He did that today. His access is quite shallow in most places - he thinks 1/8 of an inch. Might be a little more than that?? We have watched the touch cannulation and he is using this method. He tried making a fist today while cannulating and thought that may have helped - so thanks for that tidbit.
With this type of access you need to get the 3/5 inch needl, it makes no sense that if the access is only 1/8 deep that using a one inch needle to go down the vessdll wall scraing the sides with the sharp needle. It will weaken the wall use the 3/5 needle please “save your access”
Thanks - I will tell him to ask about the shorter needles. They don’t seem too willing to be flexible so not sure what they will say. I wanted to ask you one more thing. He is a smoker. And my guess is that he smokes a cigarette on the way to dialysis, so he would be cannulating within 35 to 45 minutes after smoking a cigarette. Do you think this could be causing any of the issues? He knows he should quit smoking (believe me the doctors and I have mentioned it a few times) but he doesn’t seem to want to try. He is 78 years old and says there are so few pleasures left in life! ?? I guess it’s a strong addiction.
did you get the 3/5 inch needle? if so did it help?