Does anyone have a graft and do daily home hemo?
I had 2 grafts and both failed. The first developed a puedo-aneurysm,
and the second got infected. I now use a permacath.
I wouldn’t think using a graft would be a good idea for anyone
doing home dialysis. Am I wrong here?
I think many doctors don’t think about home dialysis when
they prepare people for dialysis. I think they should take in consideration
you may need to hit these grafts on a daily basis and they might not
be an alternative to a fistula.
let me know what you think.
I had a graft once, it only lasted one year. After that I had a fistula placed on me, a short fistula…its was in 1984…I still have it and use it today…
The nice thing about the Buttonhole Technique is that you can have a very short fistula and it will still work. Even if you’ve had grafts fail, it may still be possible to do a fistula. You might try asking your nephrologist which vascular surgeon he would go to himself or send a family member to. The best access surgeon isn’t necessarily in your area–and vessel mapping (ultrasound) should always be done before planning an access.
According to my surgeon of 40 years of experience, he has seen many buttonholes have many problems The University of Cincinnati always uses mapping before the surgery. My surgeon is considered to be the best in Cincinnati. He said most grafts last 4 years and some are going strong at 6 years.
Just to reiterate…Buttonholes can only be used on fistulas, not grafts. With grafts people use the rope ladder technique and grafts are used by many people who do home HD.
Can your surgeon provide more information about what led the buttonholes to have problems? For example, does it make any difference if the buttonholes are established by a nurse compared to being established by the patient? Does it make any difference if they’re cannulated by one consistent cannulator or by several people? The reason I ask is that it’s recommended that the same person always do buttonhole cannulations. However, in busy dialysis clinics, the technician or nurse who will do the buttonhole cannulation from starting the buttonhole to cannulating for each dialysis treatment could vary from day-to-day and their skills could vary as well. The angle of entry in a buttonhole is extremely important and the angle is likely to be slightly different with different cannulators which could make the track larger than it needs to be. Also, how someone removes the scab on the needle sites in preparation for cannulation if done incorrectly can be a source of infection. Hemodialysis accesses are prone to infection if they’re not cared for appropriately, whether by the nurse or technician or the patient or partner.
[QUOTE=Beth Witten MSW ACSW;19739]Just to reiterate…Buttonholes can only be used on fistulas, not grafts. With grafts people use the rope ladder technique and grafts are used by many people who do home HD.
Can your surgeon provide more information about what led the buttonholes to have problems? For example, does it make any difference if the buttonholes are established by a nurse compared to being established by the patient? Does it make any difference if they’re cannulated by one consistent cannulator or by several people? The reason I ask is that it’s recommended that the same person always do buttonhole cannulations. However, in busy dialysis clinics, the technician or nurse who will do the buttonhole cannulation from starting the buttonhole to cannulating for each dialysis treatment could vary from day-to-day and their skills could vary as well. The angle of entry in a buttonhole is extremely important and the angle is likely to be slightly different with different cannulators which could make the track larger than it needs to be. Also, how someone removes the scab on the needle sites in preparation for cannulation if done incorrectly can be a source of infection. Hemodialysis accesses are prone to infection if they’re not cared for appropriately, whether by the nurse or technician or the patient or partner.[/QUOTE]
[QUOTE=Beth Witten MSW ACSW;19739]Just to reiterate…Buttonholes can only be used on fistulas, not grafts. With grafts people use the rope ladder technique and grafts are used by many people who do home HD.
Can your surgeon provide more information about what led the buttonholes to have problems? For example, does it make any difference if the buttonholes are established by a nurse compared to being established by the patient? Does it make any difference if they’re cannulated by one consistent cannulator or by several people? The reason I ask is that it’s recommended that the same person always do buttonhole cannulations. However, in busy dialysis clinics, the technician or nurse who will do the buttonhole cannulation from starting the buttonhole to cannulating for each dialysis treatment could vary from day-to-day and their skills could vary as well. The angle of entry in a buttonhole is extremely important and the angle is likely to be slightly different with different cannulators which could make the track larger than it needs to be. Also, how someone removes the scab on the needle sites in preparation for cannulation if done incorrectly can be a source of infection. Hemodialysis accesses are prone to infection if they’re not cared for appropriately, whether by the nurse or technician or the patient or partner.[/QUOTE]
Hi Beth,
With proper training and technique, buttonholes can be used for those who dialyze in-center 3 days per week. The center in which I belong has been using buttonholes for the in-center dialyzors for over a year and it has been working out great for everyone. The same tech/nurse is not always the one to cannulate. Just goes to show with proper training it is a task that can be done…
Want to mention that Satellite Health has started trialing buttonhole prep by using I.V, type needles that are left in for about 14days to establish track, no need to insert sharps seven times or more.
Gues,
I have heard of this technique before. The name ecapes me at the moment. But I was told the reason more dont use them is the cost associeated. Hmmm There is that C word again…
Very cool! And, knowing Satellite, they will publish their results. If positive, this approach will give clinics another option for getting Buttonholes started–and one that doesn’t require the same cannulator for 8-10 sessions in a row (which is next to impossible to do). And I’d bet that IV needles are quite a bit cheaper than the–unbelievably poorly named–“Biohole” (?!!) product, which is a sort of plastic “thumbtack” for the same purpose.