Do you flip?

The last couple of months I have had numerous problems with pressure readings, particularly arterial, which still persisted after I started buttonholing.
The last few times I have turned the arterial needle 180 degrees and lo and behold no more problems. Seems it stays free of vessel walls. No problems over 8 hour runs.
Was wondering do others do this? 8)

Oh definatley, now and then you just have to move them a bit. Worsest scenario is when the needle clots needing to reinsert a new needle quickly…

Yeah, I try everything before I give up. How old are your button holes?Somestimes when the tunnel is well develped that problem will go away.It did for me Mine are a bout a year old now,no problems ever …unless I rush.

Thanks guys
Only been buttonholing about 6 weeks , still a learner. If it is anything like my pierced ears I am sure it will get easier :lol:

Mine are a little over a year now and seem to work quite well than several months ago…I have two sets…2+2 …rotating back and forth…

Hey Gus
You shouldn’t have mentioned that clot word! After having a couple of smooth runs, my arterial buttonhole went and clotted twice! ( i don’t have another set yet as my fistula is not that big) After having 4 stabs in the dark(so to speak) last night and this morning I am now waiting for my nurse to do a home visit and hopefully save the day!

So you really had that scenario, hmm…it will happen to all of us doing home dialysis, well, in rare cases, and have found that the fastest and most efficient way to deal with it is by just leaving the clotted button needle in there and insert an AV sharp needle right away and continue dialysis without hassles…

On a side note, next time you do dialysis prepare one syringe with saline and use that to clear up the first buttonhole needle once insterted, then after getting remaining buttonhole in you won’t have to worry the first buttonhole needle getting clotted…

But also you mention that your fistula is not well developed yet? So that’s quite difficult…try excercising your arm where you have the fistula, squeeze wet towels everyday for 15min…

Hope all goes well for you…

Thanks Gus
I am sitting here waiting for nurse to arrive in a couple of hours, with 4 band aids (plasters?) decorating my arm wondering where he will try and put needles in! Trying to stay positive! :frowning:

Hey no problem, of course hang in there!

Btw, out of blue an ugly scenario happened to me this evening…as I was getting ready to come off, I de-activated the recliner to lay my legs down to come off as that same moment my venous buttonhole needle came out! Yikes… :shock:

splurt, splurt, gushing, GuSher all over! I quickly got in action, no time for gloves for me but used plenty of Purell before touching, machine was turned off temp and clamped venous line tillI get that needle back in!..Luckily, it went back in and was able to terminate treatment normally, BUT heck…my room looked like those freaky zombie video games…eEEek!..

Well there you have it, out of blue…such ugly scenarios that just haunt you…but hey, I was prepared well to know what to do… 8)

Our bedroom would have kept CSI team busy for a while this morning too! Glad to hear your quick thinking working. I don’t think I would have got the venous needle back in without flooding the room!
Had success with nurses visit. He found I had gone through the bottom end of vessel and he just bought the needle back out a bit.
Felt pretty stupid but I just did the same thing I have done for weeks. He reckons I have grown muscles and the vessel has moved. Hah, I think he was just being kind!
At least he had a nice drive up the coast and got to spend a few hours away from the hospital and even though I have wasted a whole day and a lot of consumables, I don’t need to do Nocturnal tonight and we can have a good nights sleep!!
Cheers and thanks again 8)

Thanks so much for posting your experiences, especially the difficult ones! It helps to know that problems are going to occur and can be handled.

Gus, if that ever happens again, don’t reinsert the same needle. First at the end of the run you can return the blood through your arterial site and just hold the venous and tape up. Instead of putting the saline on the arterial needle, hook the venous line to it.

If during the earlier part of your run, change needles. It could be contaminated.

Be sure to watch for any signs of infection.

home hemo 9/04

ps, if it sounds as if I speak from experience, I do!!

There’s alot more I didn’t mention in my post, other observations were made before re-inserting the needle back. For exmaple, things like whether the needle touched contaminated surfaces which in most cases brings other solutions but in my case the needle didn’t touch any contaminated surfaces…it was taped up to the arm and just dangled…

If it became contaminated, then of course wouldn’t re-insert it back…but the needle was there close, less time to deal with it than removing all tape and doing as you suggested, Still your suggestion is the safest way to go and would keep that in mind next time. The way it would work for NxStage is a manual reverse blood return…

Other questions arise, what would you do if it happened midway during treatment?

A. Disconnect and recirculate while inserting new needle
B. Terminate treatment
C. Temp Stop machine and insert AV sharp and reconnect
D. Other

I would insert a new blunt in the same site, while the machine was stopped. I always keep an extra needle on my table just to ensure I won’t need to!!

To be honest, I too inserted my original needle as it was taped and hadn’t touched anything, but, boy was I lectured!!

I should be trying the NxStage in March, so I guess I will learn how different it is from the Fresenius.


I am trying to picture how you insert a new needle in same site without turning the room into that crime scene?? :shock:

I am trying to picture how you insert a new needle in same site without turning the room into that crime scene?? :shock:

Very quickly :lol:

who actually stops bleeding very fast (two minutes), but who did leak while reinserting needle, but the needle does stop/slow the blood flow and it does go back in quickly.

Absolutely, as quick as you can get, no waiting, no delays…

there’s bleeding and a big mess while this is happening…RARrrr! :twisted:

And you clearly can see the hole which is why its simply easy to put back in, its literally still open, the canal is there and the needly will just slide in without strugging…

However, time is critical so you can’t wait long to solve this or else the blood in lines may dry up…so there’s choices to make but depends on observations, quick thinking and reaction time…

However, I do think the safest route to take is just returning the blood manually whether its reverse or forward return without inserting needle back and re-starting, depending on the time it occured…

No question. In my program, missing one daily treatment is not significant enough to risk introducing bacteria or air into the bloodstream. If something clots, and it can’t be cleared by a saline infusion, you take yourself off. You try not to lose the blood in the circuit, but if you have to, you have to. It’s not that big a deal.

Beachy, I don’t know why you’re having the fluctuating needle pressures. It’s pretty hard to be on dialysis all night with alarms ringing, so you need stable pressures. Maybe it’s because your fistula isn’t fully developed yet, but I do know that even with a buttonhole, there’s more than enough leeway going in that if you’re not extremely careful while taping, you can easily move that needle from the middle where it should be, and then, as soon as the tip gets close to the vein wall, you get alarms. The same thing happens if you tape it down too tightly. That changes the up and down angle, and again, you get alarms. Once my needles are taped carefully, I don’t put anything else over them except the leak sensor - no mesh sleeve or anything. That would cause alarms for sure. Occasionally, I might tape one of my needles down too tight with the tegaderm. Then I get alarms, but I resolve that by simply squeezing in another 2x2 gauze under it. That usually solves the problem. One problem with using Tegaderms to tape down is that the needles can’t really be repositioned once taped down. So, that’s why you have to be very careful when taping them down in the first place. Nobody’s perfect, so we all just do the best we can.