gus writes:
Worsest scenario is when the needle clots needing to reinsert a new needle quickly…
When the needle clots is it usually a one time thing or can it indicate a more serious problem? Do most have 2 sets of buttonholes so the alternate can be used in a case like this?
Gus writes:
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…
Is this the usual protocol for buttonhole?
The standard practice in my program is to flush the needles with saline. Why? Because when you needle your own buttonholes or even sharps, it can take quite a bit longer to complete the whole process than if a nurse did it. Especially with buttonholes, sometimes you need to fiddle with it for a while before it goes in. If the needle already in had not been flushed with saline (and the blood drawn into it), it might clot while it’s just sitting there waiting for the treatment to start. It’s also useful as a check to ensure the needle is in fact into the vein.
Pierre
Pierre writes:
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.
Trying to picture what you are saying here, because I haven’t seen how needles are taped for buttonhole. What is the method?
I do not flush, was not trained to. I also only take about 2-3 minutes to get both needles in and tape. But sometimes one clots. All I do is get a syringe and pull the small clot out. Very easy.
Cathy
Cathy, Pierre, Gus, Pat for hubby do you have 2 sets of buttonholes?
Yes, I have two sets, used the first ones for almost 6 months, then established 2nd set. They recommend it so that the “irritation” doesn’t get so bad, and to give them a bit more time to heal over and create scabs.
Cathy
Only one set of buttonholes here. There’s no reason for a buttonhole to stop working. More likely the whole fistula will eventually fail or clot or something.
On the subject of taping, when I prepare my needle tray, I fill 4 20ml syringes with 10ml saline each, I cut a 10x12 Tegaderm in two halves, etc. I also take the precaution of washing my arm with soap to be sure the Tegaderm will adhere well overnight.
Once the machine is ready, I put the needle in, stuff a couple of 2x2 gauzes under it (folded in half), apply half of the 10x12 Tegaderm over it, then I pull up blood into the already attached syringe (it has 10ml saline in it, some of which is already in the flushed needle tube because I flushed it when preparing my needle tray). This ensures that the needle is working OK. Then I do the other needle the same way. Once both are in like that, I connect the arterial, then venous, and I turn on the treatment. Once treatment is running and the heparin bolus infused (via the heparin pump on the machine), I continue my taping by taping each needle line to a 4x4 gauze cuff I made and put on my wrist, and finally I tape the leak detector’s sensor just behind the venous needle. I use a burn mesh sleeve only to hold the leak detector body, not over my needles.
Keep in mind that with nocturnal, you need more secure taping than you might for short daily. For short daily, I can secure the needles with paper tape the same as they do in-centre, but that would not be secure enough for nocturnal.
Pierre
Absolutely not, when you flip your buttonhole needle you are csoring your tract. This is going to damagr your flap that has been formed. This is like coring an apple. Do not do this if you go to the manufactuirers site they will tell you the same.