Are all patients that are using the buttonhole technique for sticking, having both needles go up? Can the arterial go down? Thanks

My Arterial goes up - pointing into the blood flow - and my venous goes down - pointing with the blood flow.

I use both ways, up and down…2 sets…in my example they’re a little over an inch apart…not too close. I think having 2 buttonholes too close together poses some risks of skin injury or infection or both…

I thought I had read that you cannot have your arterial pointing into the blood flow so I had my center check it out. They found out that they can go either way, just make sure that your arterial will not pull the “dialyzed” venous blood, the ends of the needles should be a good 2-3 inches apart so you aren’t getting recirculation.

The arterial needle can point either way because it’s just sucking blood out (decided when you start the buttonhole, for those who aren’t familiar with it). The veinous, because it’s putting blood back in, has to point in the direction of the blood flow in the fistula. It would still work anyway, whichever way the needle points. It’s just that it would affect the efficiency of it (recirculation, mostly). A buttonhole, once established, would, hopefully, be used a long, long time. So, it has to be done right the first time.


Hi,Alan here,i have tried having my venus go down,but it depends on how long + big yor fistula is,but what do you mean about sticking?I do have both needles go up,is your fistula big enough?.Started buttonhole 4yrs ago,i feel its better than going up+down the fistula,because it deletes the sharps. Buttonhole needles are blunt,well bioneedles are blunt more to the point,good luck,am usually about,Alan

You might want to watch this webinar on Dr. Agar’s opinion about how to cannulate fistulas that is achived from February 24, 2010. It makes a lot of senseto me.