hi amba, thanx for you comment on buttonholes. i still think that this techinque will do some damage to the fistula,how long have you been using this method? is it hard to put blunt needles into the skin? because you would have to break the skin would’nt you? can you tell i dont like the idea of needling? :o :oops: any way, i’ll get there one day. take care.
And explanation on buttonholes…
First of all you pick a good spot to cannulate. Then after approx 6 times of cannulating in that very same spot with a sharp, you can move onto blunts. It may take more than 6 times to develop the “tunnel”. When I say 6 times, this is 6 treatments, not 6 times in one hit.
By cannulating in the exact same spot each time, you develop what is called a scar tunnel. The reason the risk is minimal, is because you are using the same spot, and a blunt needle. You are not piercing the skin and the fistula each time.
Once this tunnel is developed, you can use blunt needles. Before cannulating, you pick the plug/scab off the buttonhole site. You then clean the skin per protocol and cannulate going at the same angle each time. The blunt needle slides in without causing trauma, and minimal or no pain. You can use local if you wish.
Blunt needles also eliminates the risk of infiltration. Infiltration is where a sharp needle goes through the other side of the fistula (on the inside), causing an internal bleed. Blunt needles will not infiltrate as they cannot pierce skin.
Occaisionally, the buttonhole can be difficult to get a blunt in. You just try it a few times using a new blunt each time. If unsuccessful then use a sharp. If using a sharp in your buttonhole it is important to go at the same angle as you would with a blunt, so as not to damage your created tunnel.
I hope this helps, it is hard to explain. Anymore questions just ask. Ask just about anyone that does buttonholes and they will tell you how much better they are than using the ladder method with sharps. Even the surgeons agree!
hi amba, thanx again for replying. i still cant get my head around this “buttonhole” technique.i know you’ve probably used this for year’s and swear by it, because i have’nt seen nor heard about it, it’s hard for me to comprehend. i will ask the nurse about this when we go tomorrow and see what she says about this.i’m sorry to be a pain about this.
Hi Hellen What hospital are you with. I am with Monash. Heparin is available in 35ml bottles with a rubber seal. A lot easier to hit the target. Peter
Thats ok helen. I hope you can do it, it really is a much kinder technique for the patient.
Amba:
If using a sharp in your buttonhole it is important to go at the same angle as you would with a blunt, so as not to damage your created tunnel.
How does the one doing the sticking know he is going in at the exact same angle each time?
Buttonholing has actually been done for years and people who are familiar with it say that it actually prolongs the life of the fistula which is why as daily dialysis consumers most of us use the buttonhole technique if we have fistulas. Especially with a curvy fistula (as mine is) as there aren’t that many places to stick so continually sticking in the same area without a buttonhole may cause the fistula to develop an anurism.
Another benefit of the buttonhole is that bleeding is pretty much eliminated on the insertion of the needle and stopping the bleeding at the end of the treatment is quicker.
Do you have pierced ears?? Buttonholes are similar to that. It doesn’t hurt to put in your earrings because a “tunnel” has been created. There is a video on the home page of this site with additional information I suggest you read it and maybe get your center to read it.
With regard to inserting the needles, I think you need to do it sooner rather than later. I believe this can be the hardest thing to learn how to do correctly. I’m not sure how long you are in training, but usually 4-5 weeks in the max, and since you are already starting the 3rd week it is time. I have an essential tremor that is pretty bad but can insert my own needles. There are days it is harder, but my tremor subsides when I rest my hand on something so I rest the heal of the hand holding the needle on my arm and it allows my hand to be relatively still. Maybe your husband can try this trick. If not, the only way to get over your fear is simply to do it.
Cathy
home hemo 9/04
Its all a matter of practise in getting the angle right. Just take note of what angle your going in, and how you hold your hand when inserting. If you are going into the same spot each time, generally the angle is going to be much the same each time anyway, as you cant really go too far off track or you wont get into the fistula. Over time you will know what angle is best and where. Its just a matter of persisting until you get it. It took me more than 6 cannulations to get a blunt in, everyone is different. Once you get it, you wont ever want to use sharps again. Alot of people no longer need local. I still use it as I still get some pain, its really up to you.
Hi Helen
There has been lots of discussion on buttonholes over the time on this forum.
Here is one of them http://www.homedialysis.org/boards/viewtopic.php?t=632&start=0
Honestly, it is fantastic! I have only been doing it since January and I LOVE it!! It is the best way to go if you have one person doing the cannulating consistently. If your nurses don’t know about it, then they are not up on their knowledge. As usual we Aussies are a bit behind the Americans but…we are catching up
I started buttonholing about 5 months after starting dialysis which was enough time to develop my fistula up enough. The folk on this forum gave me courage to persist and it worked like a charm and is much, much easier on the fistula. No stress either in deciding where to put those suckers in!
Cheers 8)
hello all, again thank you to all who replied to my post, peter, we are in the royal melb. at parkville, that is thier training centre. we are in there for 6 - 8 weeks. cathy, i know i have to do it, i just have to get the guts to do it, it is hard, i’m just thankful that the nurse’s have’nt pushed me , otherwise i would say no, because i am the one who will be doing the needling i want to do this at my own pace, the nurse’s are more than happy with this. i have asked the nurse’s about the buttonhole technique and they do not recommend it, they know about it, also the surgeons also dont like this procedure. so i will get there. thanx again all. take care.
Helen, did they give reasons as to why the nurses and surgeons dont recommend the buttonholes? I cant imagine why!
I can’t imagine anyone in nephrology not being pro-buttonhole at this point. No harm but obvious benefits. One of them might be prolonging fistula life, but the single most important benefit for home hemodialysis is that you get way more predictable cannulation each treatment. Infiltration becomes a thing of the past, as there’s no way that dull needletip is going to cause that. And even if it did, the established buttonhole means that there’s no guess factor at any time. You’re either in, or your not. If you’re not, the dull needle isn’t going in at all, but otherwise, it’s always in the same place.
This is totally unlike traditional sharp needle use, where every single cannulation can be an adventure. It’s one thing for nurses in a dialysis centre to do this, but the last thing you need when you’re doing this at home is to have to stop everything as you try to deal with infiltration and hematoma!
I can understand your fear. I sure wouldn’t want to be responsible for cannulating someone else with a sharp needle at home.
Pierre
I agree with you pierre. The bleeding thing is very scary! I have bled once, and lucky my partner hadnt left for work yet as blood poured out. I got him to pull the needle out but he did it too slow, so the blood gushed out and all inside as well.
I do have a box of sharps at hand just in case though. On occaisions I have had to cannulate somewhere else using a sharp and its not real nice when you are on your own with no medical staff around.
Hi Helen. I’m very surprised that your center has not been supportive of the Buttonhole technique–it’s been around for at least a couple of decades, and promises to help fistulas last longer. It also causes less pain when the needles are put in, seems to cause fewer aneurysms, and it’s faster to do.
Here is an article about it that you can print off and bring to your center: http://www.homedialysis.org/v1/rotating/0506topicofthemonth.shtml. And here is a brochure with photos that Medisystems provided for us–you can print this, too, and show it to your care team: http://www.homedialysis.org/v1/types/buttonhole.shtml.
A couple of things–you said that you will be the one putting in the needles. Why isn’t your husband doing that for himself? Is there a reason why he isn’t able to? Also, I can tell across a number of your posts that you are very scared and stressed right now. Please know that this does get much easier in time, and you will get more comfortable with it. Right now, it’s the unknown, and it’s scary. The more you understand and the more you do it and find that there really are very few problems, the better you will feel.
I’m also going to suggest that you think about visiting the Coping module of our free Kidney School which you can go to on-line (or download the modules as pdfs) at http://www.kidneyschool.org. You might also want to read the module on Vascular Access.
hello everyone, just want to let you guy’s know that we have decided not to continue with the home dialysis, hubby will go to a satallite centre to do his dialysis, he did’nt want to make the decision, so i did, i decidid that i cannot do the needling, this is just one thing i cannot do. hubby is o.k with this and thankfully the staff at the training centre are too. i was just feeling so pressured to do the needling, and i did not like the idea of inserting a needle into a vein. it’s a personal thing. i felt so bad when i told the nurse, i felt like i had let them down, they said that i/we had’nt and not to feel bad. you would not believe how relieved i felt after we left. it has taken a lot out of me these last 3 weeks, i was getting so stressed, but anyway i just wanted to let you guy’s know, you’ve been great with my questions, thank you and take care.
Helen, it does sound like you were being rushed with your training and doing the needles. I think its important to take your time and do it when you ready. One couple took 6 months of training before they were comfortable to go home. Perhaps if they could let you train longer you could do it? In the long run, home dialysis is much better for you, and once you get over the initial fear, its not all that bad.
hi amba, thanx for your reply, no they wont let us keep training, but they have said that if after andy goes into satalite centre and we want to go back to training then they will let us do that. but it will be for 6 weeks only, that is the max. time they allow for you to learn everything. for me i dont think that is sufficent time to learn everything you need to know, then again maybe someone else can learn it all in that short time. we were told that they have a lot of people pull out of training, they did say that most pull out once they get home and discover that they cant cope with it. but we will see how we go this way, at the moment they are letting us stay in the training centre until they can find a spot for us in a centre close to home. thank you for all your comments. take care.
Im sorry you have to go through that helen. I think 6 weeks to train is appauling, and unsafe. It took me 2 months before I was ready to go home, and I was the quickest to learn apparently. They give you a general time of 12 weeks, but its not a deadline, if your not ready by 12 weeks then you can stay until you are ready. They take things slowly, to make sure you are well educated. I think it is dangerous to rush it, especially if you are someone who has absolutely no prior experience of any type.
And they wonder why they have a high drop out rate!! :roll:
With NxStage we were told they have a limit of 3 weeks to train. Is it that much easier than a traditional machine?
I think it is very possible to train on the NxStage in 3 weeks, I learned the machine and set up in one day, plus they have step by step instructions that are extremely easy to follow. Most of the time you will spend learning cannulation, taping, and what to do in emergencies, that is what takes the longest time.
I only trained for 3 weeks on the Fresenius, and still needed to follow my “cheat” sheet (I wrote up my own step by step instructions) for quite a while, the NxStage with the cartridge system and no r/o is significantly less complicated.
Cathy
home hemo 9/04