Do i need new buttonholes or?

Well, we have our new machine and i have loved it from the start but wondering if anything could be wrong with it, or …if it’s Bo’s fistula, my sticks or??? thats causing us to get 24 alarms now, when we wernt so shortly ago. First, it just seems that I am haveing to press with real force to get through the toughened skin at the entrence of the fistula,( then, i can use the ‘touch’ method as it does slip easly into the tunnel)… It’s almost like a wart. When we just started, i know i probably thickened it by scrapping to vigerously on the area to get scabs, and skin off it. Is it time for new buttonholes? and, another question is … For the first hour or so, his pressures run A 115 V 117… and E very close to those numbers as well. Then, after an hour or so, his A will shoot up. What im seeing is that the area (vein) just below the A needle has got more hump to it now and the wings of the needle are touching it and making it have more pressure. Also the angle of the V has changed and the wings of that can press on the tunnel area of the A … Thats what ‘seems’ to be at least part of the issue, but during this time, if i sit him strait up, with feet down, it seems to take care of it as well. Whats going on here??? I miss our smooth runs :frowning:

ps… how do i encourage our center to let us use (and for them to provide) the 3/4 needle. They are completly uninterested in letting us do this. Also, his fistula is in his lower left arm and we dont have a lot of area to work with…


dont know if it worked but if it did, heres a picture

Ok let’s start by cleaning the site for cannulation. Place the exfoliating facial sponge (buy at Wal-Mart) under hot water for 30 to 45 seconds, and then apply one to two drops of antibacterial and with moderate pressure in a Circle 10 to 12 times. This will take all the extra scab off and loosen the scape at the tunnel entrance. This should help getting the needle in. How deep his vessel, you find this out when you cannulated look at how far the needle is in before you have a flash back, I need to know this.I will check with my nexstage personal for the rest and give you the rest of your answer on Monday Nite late

Thank you Stuart for your interest. I will start by saying i will be getting one of the exfoliating sponges and have him clean the area like that. Another thing is, Bo (hubby/patient :slight_smile: ) has just started using the emla cream on his buttonholes which is really bugging me as he has never used before and someone suggested it to him and now he thinks he too should use it… Whats your take on that? Also, His vessel is very nice and shallow… well, except the thinckend skin? at the entrance of the tunnes. (i think you can see them in the picture) I really believe the shorter needles would benifit him as his spacing between the A and V just makes the mesurement. Now, on the brighter side, today, when i cannulated him, i straightned out his V needle in the same position as we have done previously to it “looking” like it had turned. He could move around, sit up, or what ever and pressures stayed all between 100-120, running at BFR of 310… Again, i thank you for your assistance and sure hoping for some answers on those short needles as well (if you still think they may help us out some)

Emla cream on his buttonholes, is not need . The one big reason for buttonhole site is that there is no pain versus the rope ladder using sharp needles. Exfoliating facial sponge is used 10 to 15 min prior to cannulation letting the fluid set for a short piord loosen the scab so that it comes off with ease. After you wipe off antibacterial soap apply your Betadine and follow the procedure by your training nurse. You might what to try the short needles it sounds that you have a small bend in the access site try them if there work use them. I will try and posted the whole article to the web page this week with Doris permission I’m waiting for a release from Nephrology Nursing Journal. When you find out about the short needles let us know pople that resd this will be intrested in your answer.