Buttonhole Technique

I just posted a rely to a post and would have been better to start a new thread with my question.
My husband has just started In-centre HD and may do Home HD in the future. He does not have a fistula, he has a graft as his veins were too small for a fistula.
They told us at the Centre you can’t do the buttonhole technique with a graft, is that right?

That is correct. It is NOT possible to use the Buttonhole technique with a graft. Fistulas are made only of real blood vessels–an artery is linked to a vein, and the vein grows large enough to be used for dialysis. Arteries and veins have muscle fibers in their walls. Each time the needle is pulled out after dialysis, the muscle fibers snap closed over the hole. This (along with the pressure put on the needle sites after dialysis, which compress the needle tract) allows it to heal.

Grafts are synthetic veins. They don’t have muscles. When you put in a needle and pull it out, it leaves a permanent hole. Putting pressure on to seal the needle tract so a scab forms is all that prevents bleeding. So, the Buttonhole technique is not safe for grafts.

It’s terrific that your husband is thinking about doing home HD in the future. When his graft was made, and his vessels were “too small,” was that by physical exam, or was vessel mapping done using ultrasound? Vessel mapping should be done, as it is not always possible to get a good “look” at the veins just by feeling them–many more fistulas can be made when vessel mapping gives the vascular surgeon a clear picture. Your husband might be able to get a fistula in the future, even though he has a graft now.

Thank you for your reply. I think he had ultrasound to check his vessels, I know the vascular surgeon said they were just mms. We have an appointment to see her next month as she removed the catheter, so George has to go back to have that checked out. I will certainly ask her if it possible the have a fistula in the future. If it is possible would he have to have it put in his right arm as the graft is in his left?