Must be the month for mishaps or maybe I am just losing confidence):
Having trouble getting my arterial buttonhole in, been missing a few nights and having to try again next day. Starting to feel very tender and after speaking to Bear, starting to realise how tenuous this business really is.
Thanks to hubby working out my angle of entry was getting too shallow, had success on retrying this morning but geeeeeeee you can lose confidence quickly. It wears you down when you have a few failed attempts too.
Problem with having a small fistula and buttonholing early on in development, is that I don’t have much success finding another place to go in with a sharp instead of just skipping a treatment.
Guess, it is just like falling off a horse though, got to get up and try again, but sometimes it all seems too much.


I have had those feeling too but your right you just gotta get up and keep on going.

At some points I have gotten the low downs on session days but I have tried to be as patient as I can, no matter if it takes a little longer and if I can’t and get to a point of exhaustion then I use the sharp needle…

Hi beachy!
Do you put in your needles or does your hubby do it? Patient we know explained that he had some days where he couldn’t get the needle in to save his life and thought the tunnel must of closed up, going by what he heard others say. But then when he was about to give up and go for a sharp, the needle slid right in. So, he said he realized the tunnel was there, but he was missing the entry. Could this be what is happening to you? Patient said once he figured this out, he now knows how to find the entry better and gets right in everytime. Also, he said when a patient self-sticks one can find the entry better.

Does anyone at this board put the needles in for your spouse? I would be interested to know how easy/hard it is to find find the entry?

Hi Heather
Yes, I definitely do my own needles. Hubby is there for support etc. Can’t imagine someone doing needling for me with buttonholes. I squirm when hubby tries to get a splinter out of my foot!!
I found that I was going in a bit too shallow after all these months, hubby has a very good eye (he makes guitars) and worked out I was inadvertently changing the angle (ever so slightly) but enough and I was hitting scar tissue.

Hi Beachy

I remember having that problem now and then. One night you may not go in quite at the right angle, you scrape the sides of the tunnel, it causes injury to it, causes scar tissue to form… and then you find yourself having more and more trouble getting the needle in as it hits the scar tissue which is now in the way. The dull needle tip has trouble piercing through it.

There is sometimes no alternative but to go in with a sharp. I never fiddled with mine more than a few minutes, because the more you do, the more chance of getting some clotting in the needle before you can start the treatment, plus, it kind of chews up the buttonhole and makes the problem worse. I was always successful in re-forming that tunnel after very carefully using a sharp a few times. I estimate I must have used about 15-20 sharps altogether during the course of the year and a half I was dialyzing at home. It happened in spurts, where I wouldn’t need a sharp for months, and then all of a sudden, I had problems for a few nights.

I have to say that I never needled with a sharp in a new place at home. It’s just not practical to do that for nocturnal. There’s too much risk of infiltration while you sleep, because any new needle site is going to be unpredictable. Might be Ok if doing a short daily instead that or the next day. When you’re on nocturnal, there’s no problem at all choosing to do a short daily treatment now and then for whatever reason. Personally, I would prefer that over missing a treatment completely.

In our home hemo program here, if you start having frequent trouble with a buttonhole, they bring you into the unit for a few days of short daily, and if necessary, you start a new buttonhole. That happened to me once, about 3 months before I got my kidney transplant. Sometimes, tissues just shift in there over time and you just have to accept that you need a new buttonhole. Somehow, the holes just don’t line up any more. I hope that doesn’t happen to you. It’s a hassle to start over with a new one, but it’s not the end of the world.

They didn’t do this at the time when I trained, but I know that many of the later patients established 3 buttonholes during their training period. Not 4, but only 3. It provides extra insurance in case of problems, and it’s easier to maintain 3 than 4. The unit was thinking about bringing me in for a 3rd buttonhole at about the time I got my transplant. Here they definitely do NOT encourage sharps in a new spot at home for nocturnal, so a 3rd buttonhole gives you an easy way out should you encounter a problem. BTW, I couldn’t really do this on my own at home because of how my fistula was. Very twisty and dipsy, and not much room for new needle sites other than the two existing aneurysms from the initial 2-1/2 years on in-centre hemo.

Thanks for your support, Marty, Gus and Heather. Every little bit helps and Pierre it is SO GOOD to hear from you. Your voice of commonsense and reason instantly calms me down! I can go on tonight with a bit more confidence after reading your post.

Funny, you may be at the other end of the world, but you could be here in the same room sometimes, helping me get through another tough patch!