Educating my center in buttonholes

I started my buttonholes this past summer, first cold turkey on myself and when that failed, a tech started new buttonholes. They were established in September - but I haven’t been able to have the same tech continuously until just this week. (After much begging on my part). I talked the tech that is going to be my dedicated cannulator into doing the “touch” technique and it worked GREAT!!! I also asked her to pull the needles out a bit to avoid hubbing.

My major problem (other than getting the center to work with me on having the same tech) is that I have to hold afterwards for at least 30 minutes and as long as two hours. My fistula surgeon did an ultrasound on my arm and was very satisfied with the fistula. It thrums, buzzes, and vibrates like a champ. He felt no need for a fistulagram (which is what the center keeps harping at me to do). I think that the buttonholes have been enlarged by all the fishing around, even forming a phantom channel right above the real channel. I also think that if my tech continues to be successful like she was today (gliding the needles in like into butter), that my tissues will respond and the bleeding will lessen. Any thoughts??? (Also, I requested them to reduce my heparin and it is now two-thirds of the bolus - no maintenance.)

Thank you - you are highly recommended.

What great news that you have a tech that uses “touch Cannulation”. Tell her thanks from me that should get a good conversation going. Now to you buttonhole. First what is your blood flow, and blood pressure did you have a cath in the chest before you got your AV/f.Were is your access located at upper arm and how deep is. Let me know this will help with my evaluation\

Thanks look forward to reply

Hi can you answer my e-mail i need to know to answer your qustions

Sorry - I have been having computer problems. My blood pressure runs around 145/90 and goes down during dialysis to around 105/70. Yesterday it ran high for some reason even though I had 3.1 taken off. I usually have around 2.8 taken off and my blood pressure is normal. The last ABF I had done was Friday and it was 2000 (the tech said it was very good). I have been holding for 30 minutes. Yesterday, the tech had trouble with my venous where I have a phantom hole that I would like very much for them to avoid. I also have asked her to pull the needle out just a bit to prevent hubbing - but I’m going to ask her tomorrow to keep it snug because the last two times, that upper hole (the venous) has leaked just a little around the hole. I don’t know if that’s expected or not. I want to see tomorrow if snugging it up keeps it from leaking. Any more questions? (Sorry I didn’t get right back)

Ok the leaking around the venous site is troubling. If it was me and what I know I think I would start a new venous buttonhole. Giving the site a few weeks to rest and reform and then you can alternate site. You are setting up for hubbling problems later on if you contuine to hup the needle . How deep is the venous site you tech should be able to tell you than you can tell me. It sounds like you have an upper arm fistula.

Let us know what you decided

how is your access working? did you start a new butonhole

I did not start a new buttonhole. I think I need to start TWO. Very depressing. I had to hold today for 1.5 hours. I thought I was golden at 30 minutes. But the bottom one (this time) was the bleeder. It makes no sense. Monday I am going to use coban wraps. (I know I know - but I will be very good at taking them off after I get home.) This morning, the sticks just slid right in.

I will talk to my doctor on Monday about trying new buttonholes. (We tried a sharp a couple weeks ago that immediately infiltrated) I have a very short area to work with. (upper arm just above my elbow - and I think the arterial site is too close to the elbow)

Just how short of an area two inches and how far are the needles apart 2 inch are less? It is advise that you stay at least 1 to 1 1/2 inch above the astamoisis. When you get an ultrasound the next time see if they can tell you the thickness of your vessel walls. There is something that bothers me that you are having this much of a problem. Are you running good art pressure and venues pressure, this bleeding time apersas to me that you have a stenios, you would be the first case that I am aware of that bleeds this long. Don’t give up there has to be a solution to this. If you are shallow lest than 1/2 inch get the 3/5 buttonhole needle.

The needles are two inches apart. There is probably two to three more inches above the venous site. I’m running good pressures. (Forgot to mention that when they tried a sharp a couple weeks ago and infiltrated, they also got very little pressure, so it was in and out - in fact no bruising. That was about an inch above my venous site.

Also, I just read an article ( where it warns about “Non-stenosis-associated access thrombosis is often due to excessive fistula compression to achieve hemostasis after dialysis. Dialysis staff and patients should be educated and trained in preventing this avoidable complication.” I am reading that this way - since I had a very good ultrasound that showed my fistula was good all the way through my shoulder, that I do not have stenosis, that my holding and holding and holding might be contributing to the fact that I am holding longer than normal. I mean, it is very ironic if that is the case. I’m not sleeping on my arm - so that is not where I am getting “excessive compression”.

Ok with the ultrasound showing no problems and the access deep of the buttonhole are fine there is only one other thing that I can think of is to check blood for how thin it is . I know you said that you have cut by on heparin what is you dose. Be advice that i have seen no heparin give to several patients over the years you may be in this category. Have check out and let me know . How deep is you buttonhole do you get a flasback wright away ?

I have cut the hep to 2000 in the bolus only. The arterial is shallow, with flashback right at the end; venous is deeper, again with flashback right at the end. Interestingly, when the arterial starts to flow through the tube there is tiny clot - so I seem to clot ok.

]do you mean that the needle goes all the way in before you get flash back[/B]