Fluid leak around button hole

I am 35 and have been on dialysis for 13 years, I’ve had button holes this whole time. Roughly 6-8 months ago around the button hole it started to secrete a clear fluid that took a very long time to heal after scratching and the button holes themselves are very sensitive when they used to not be. I’ve also noticed sometimes the Venus once emits an odor similar to cheese or a foul smelling odor when after being soaked and picked before cannulation. I’ve also noticed my skin is not healing well. Is this just due to being on dialysis for so long? Or is this a sign my button holes are failing? I have become very itchy also while on dialysis that just started happening after starting at a new clinic where I live almost two years ago. Can anyone offer any insight who’s had button holes before?

Hello. Time to move away from button holes and do rope ladder. Button hole is not great long term. Yes it will hurt a lot more going to new areas, but that is much more better than compromising your fistula by repeatedly damaging the same area. Also note, as you get older your skin will begin to thin. Therefore the problem will only get worse long term.

Also as you continue to use different areas of your fistula, as you eventually go over the same spot, it will become desensitized. Even if you just needle ~2cm and change it every treatment. That is significantly better than buttonhole. So just do it and stick to it, it will get better! Also if it does bother you a lot you can also use numbing cream. I believe its called lidocaine. This should help a lot if pain is a barrier.

Buttonholes can last a long time. If well cared for. So can fistulas.
You mentioned you moved clinics. Are you using a different brand of needles. Or a different cleaning protocol?

Mine was using ‘lubricated blunt’ needles which caused discomfort. Switched to a different brand (NIPRO)
I use EMLA cream but a lot of clinics prefer patients to avoid if you can.

I’m not sure if you have all these choices where you are. I’m in the UK.

Either way you shouldn’t have discharge from the fistula site. Hope you get it sorted out.

You may have an infection. Tell your clinic about the odor. I’ve used button holes for over 16 years without a problem. I also use lidocaine/prilocaine cream.