How did you learn to put in your own needles?

[estonb]

Sorry if I am kind of late on this topic, but I just found these amazing forums on homedialysis.org and there are so many thread that I want to chime in on.

I first learned to cannulate myself after being a hemo patient only for a few months. I didn’t really do it by choice - my neph was constantly prodding me to stick myself ever since day 1. He wanted me to do it myself so that there would be consistency in my sticks and because he knew I would take better care of my fistula than any other person would.

When I decided to go ahead and try to stick myself, I told the tech that was working with me to give me a brief lesson to make sure that there wasn’t anything I hadn’t already considered about doing it myself, and then I focused on the task and bingo. I had a flashback. I was amazed not only at the fact that I had done it, but also at the lack of pain because my mind was focused on getting the stick right and not waiting for the dreaded pain of the needle to hit me.

Ever since that first time, I have aways stuck myself and been very successful at it. Right about that time, somewhere on the internet Iread about the buttonhole technique and its overwheming benefits compared to the ladder technique. I asked several techs and nurses at my clinic if they knew anything about the buttonhole technique and none did. So, I found a description somewhere on the internet describing the process of creating a buttonhole and I just started making my first buttonholes. The process of making a buttonhole is so straight forward and simple to understand, I had no problems whatsoever making my own buttonholes. All you have to remember is to try as hard as you can to use the same angle and same pressure with the sharp needle each time you stick the spot that you are trying to create a buttonhole at. It only took me 6 treatments (2 weeks) to form my buttonholes. I knew they were ready for a blunt needle when I felt a slight “pop” on inserting my sharp.

I went to my facility adminstrator and told her that I created 2 buttonholes and asked her she had any blunt needles that I could use. She didn’t, of course, since noone in her facility had ever used buttonholes. But she called around for me right away and found them at MedLine. I had to keep using the sharps for a couple of more treatments until the blunts came in. But when came in, I tried them right away and they worked just fine.

Because I had chosen to do it on my own due to lack of knowledge in the staff, everyone was real curious and usually had at least 1 person from the staff at each of my treatments come over and watch me cannulate myself using my buttonholes. Ever since I made the staff aware of this technique and showed them how easy it was to do, there have been a couple on in-services on the buttonhole technique and a few of the staff members have successfully created bottonholes on some of the patients.

There is now even a “Bottonhole Queen” who is one of the techs that saw what I was doing, learned about the benefits of a buttonhole over the ladder technique, and starting advocating hard for the clinic to officially adopt the technique.

There is a home hemo program at my clinic and it is not the policy that any patient transitioning to home hemo must first have buttonholes developed in their fistulas before training to facilitate successful sticks while at home.

I’ve been using the butonhole ever since I first did it on my own. I found out that you do need to make sure and bring your own needles because no other clinic I have travelled to has an blunt needles. I have also found it best to bring my own tweezers to remove the scabs because you may not like the tweezers they give you to use (the ones from the suture removal kits are the worst!). When I do travel to another clinic, I almost always wind up showing how I cannulate my buttonhole and go over all the benifits to at least one of the staff persons at the clinic.

I can’t remember if I read it on this thread or not, but I have to occlude my fistula in order to get my needles in my buttonhole. I have to because my fistula rolls around if I don’t occlude it which would cause my needle to go off track. I have gone off track a couple of times and I could tell from the immediate pain that I wasn’t going in correctly. I never occlude it really hard, I only use just enough pressure to keep my fistula “in line” until I get the needle in.

Having buttonholes had make self cannulation at home incredibly easy and quick to do. I really like the fact that the holes clot up real quick when compared to the clotting time using the ladder technique.

If for some reason I can’t get my blunt needle in (it does happen), I have to revert back to using a sharp for that treatment, but I cannulate in different areas than my buttonholes. I don’t want to run the risk of the sharp accidentally going off track and possibly creating more scar tissue around my buttonhole. It’s a good thing for me, then, that I started cannulating myself with sharps first so that I have no problems using them if I have to.

[Pierre]

Congratulations on learning that yourself. Just one thing though…

I think you may be defeating the purpose of using buttonholes a little if you insert the sharp needle in a different spot when the dull needle won’t go in. The main benefit of buttonholes is really that the needle sticks are consistent for the home hemo patient (since they are always in the same place, they are likely to work the same every time - same pressures, little risk of hematoma). A side benefit is that your fistula may last longer, but that’s only because you’re not getting needle sticks all over the place, just in those two existing holes. Every once in a while, something in either of my buttonholes seems to heal a bit too much and that necessitates using a sharp. But the sharp is used in the buttonhole nevertheless, not somewhere else. This is Ok because I know the angle. If you use sharps anywhere else, you will unecessarily be creating scar tissue. Keep in mind that any one buttonhole may not work forever, and at some point, you may need to create a new one in another spot on your fistual, so, you don’t want to limit your options in the future.

The aspect of ordinary stepladder needling which causes problems in the long run is that the more scar tissue you create, the sooner you are going to run out of possible needle sites in the fistula. The areas covered by scar tissue will eventually form aneurysms which will be unusable for cannulating.

Pierre

[Guillaume]

Hey Dori,

I quess by the ‘views’ number, you can see this topic is a real winner and everybody wants to know how people do ButtonHoles and how they learned, etc.

Good Job,
Guillaume

[estonb]

I’m not talking about a the same situation as you are, Pierre. You are talking about instances where the buttonhole needs to re-established in some way in order for blunt needles to work with it again. I agree with you that in these types of situations, you should use a sharp to access the buttonhole track in order to re-open it.

I’m talking about those very few cases where something doesn’t go right with your stick using a blunt needle and you are almost positive that it is not because somethings needs “fixing” in order to get access back with a blunt needle and you don’t want to keep trying again and again to get in the buttonhole correctly, which could inevitably end up causinge damage to it. Things like the scab not being all the way off and causing needle deflection, or accidentally using too much presssure on the blunt and infiltrating. These are one time things that are unusual in their occurrence and you know that there is nothing “wrong” with your buttonhole that requires a sharp to fix it.

I am very aware of the reasons why you should stick (no pun intended) to the buttonhole, even if you have to resort to using a sharp because something has caused blockage in your buttonhole to the extent that your buttonhole needs to be opened back up. But if I am pretty certain that it is only going to be a one-time use of the sharp for some simple reason like scab deflection that didn’t allow you proper access via my buttonhole with a blunt needle, I much prefer running the risk of developing a tiny amount of scar tissue somewhere else along my fistula rather than unintentionally developing unwanted and possible very harmful scar tissue in my buttonhole.

If, instead of going to a different site altogether, I did decide to use a sharp on my well formed buttonhole in these one-time cases, then everything would be fine and dandy if I knew for a fact that I would be using the sharp with the exact same angle and pressure as when I used the sharp to create that particular buttonhole. But I have learned from experience with using a sharp with my buttonholes that you can very easily and unitentionally stick the sharp in and miss the buttonhole track. I know it has happened to me before because either I felt the pain of accidental infiltration, or the blood flow with that access was not as good as with a blunt needle, or I have had to manipulate the cannulated sharp in order to get a flashback.

For me, it has been quite some time since I created my buttonholes and I can’t remember exactly the angle and pressure I used when creating them. You could argue that it is simply the same angle and pressure you use everytime you stick yourself with a blunt needle but I would argue back that even though that is technically a true statement, but since so much less concentration is required in regards to angle and pressure when sticking yourself with a blunt needle (using the pre-formed track which is the buttonhole) as compared to any stick with a sharp, just by using a blunt for sometime you no longer remember the exact angle and pressure. Even when paying close attention, a sharp needle can very easily go in the wrong direction simply due to the fact that the sharp is exactly what it is called - sharp, very sharp.

If I was almost positive that sticking myself with a sharp was not required in order to open my buttonhole back up, and that it was going to be a one-time stick, why would I run the risk of possibly infiltrating at the site where my buttonhole is, or developing a hematoma there, or even slighly altering the buttonhole’s track by the tiniest fraction which may result in bad flows from that point on?

Plus, for me, using a sharp hurts a whole lot more and a whole lot longer after my treatment (days longer) than using a blunt needle does. I do daily hemo (5/wk) and I would not be able to use the same site day after day if I were to use a sharp. It would just be too painful for me.

I do agree with you about your statement relating to the risk of developing aneurisms with the stepladder technique. But I doubt that I am running that risk by using another, non-buttonhole site, to stick myself with a sharp needle for one day.

Personally, I gladly accept the miniscule risk of developing an aneurism from one stick with a sharp than unintentionally causing permanent damange to my buttonhole sites that I rely on every day of my dialysis.

[bobeleanor]

HI Folks
I search for this on this page could not find anything?
On fistula do any you use a magnifying glass to see the hole and if so what power and i take it a free standing?
bobeleanor

[Bill_Peckham]

I was just thinking about this the other day. I think it would be helpfull to have a magnifying glass to remove the scabs and to clearly see the buttonhole. I was thinking that stamp collectors and other hobbiest eg fishing fly tiers, model makers, would use just the sort of glass that would work.