I’ve already had to do it a few times, that is, the buttonhole needle just wouldn’t go in, and I switched to a sharp needle that day. But I still inserted it the same way I would have the buttonhole needle, ie. in the same buttonhole.
No. If for some reason my buttonhole didn’t work, I would not choose another spot myself. I would call the home dialysis unit and follow their instructions. I suspect they would have me come in for a treatment there in order to establish a new buttonhole, or decide that I should use sharps and the stepladder technique. They are the experts.
I was taught to put on the tourniquet, feel for the direction of the vein at the buttonhole, and then insert the needle. If I feel a pop, fine, but most of the time, I don’t feel anything. The needle just goes straight in, and I know it’s in by squeezing the needle tube just above the needle a bit, which, should bring up some blood. If it doesn’t, either I’m not in the vein, or the buttonhole needle has clotted (the latter can happen if you have to play with it too long while trying to insert it).
I really don’t know how long it takes an experienced dialysis nurse to learn how to buttonhole a patient. I don’t think it would be very long, since it’s pretty easy for the patient to learn in only one treatment. The only difference really, is that you don’t use the land and level out method of inserting. For a buttonhole, you simply go straight it at a constant but relatively low angle of about 20 degrees.
When choosing a site for a new buttonhole, they just seem to look for a spot that allows enough room in the vein, preferably away from bends and dips as much as possible. The two buttonholes also have to be a certain distance from each other, and, you can’t buttonhole on an existing aneurysm such as you might have, like me, from 2 plus years of stepladder needling at the dialysis centre. I know my nurse was also thinking ahead, selecting two spots that would also leave room for a couple of new buttonholes if needed eventually. Whatever they do, in my program, they also have the patient seen by the vascular nurse. She has more experience with fistulas than even the vascular surgeons.