When you did your buttonhole training I would think your training nurse assessed your access and decided where the two buttonoles would go. Can you tell me how the nurse picked the two spots or did you pick the spots yourselves?
Also, regarding the way you cannulate, think I have read one should hold the arm/hand the same way each time. Would you also either use a touniquet or not everytime, because would that change the angle? Let’s say you use a tourniquet, even that could change the angle if it was tighter one time or pulled the skin back more. So it seems like everything must be consistent in order to get into the tunnels ok.
As I didn’t (still don’t) have a very well developed fistula, which had only been needled for 6 months when we started buttonholing there wasn’t a great deal of space to choose from as you had to pick two spots that hadn’t been punctured too much. We just went with what we had and so far , GREAT!
Regarding where your arm goes, it is not rocket science and isn’t as difficult as it all sounds. You just do your best each time. Yes I use a touniquet and yes, I TRY to have my arm roughly at the same angle, but sure, I do move it around slightly at times while getting the needles in.
The consistency for me is FEELING my way in. If I meet some resistence, I try swivelling the cannula slightly back and forth, or pull it back and try a slightly different angle. The beauty of the blunts is your can’t force it, you just feel and coax it in.
Someone said on this forum once it was like putting your pierced earrings in and that really struck a chord with me. It is very much like that. I often imagine that is simply all i am doing. Sometimes it just takes a bit more effort than others, but that tunnel is always there. Cheers