Need for Frequent New Buttonholes

Hi Stuart!

It’s been a long time since I had a question for you. I find that my buttonholes only last about 3 months before I begin getting bleeding around the needles. I am very careful about not hubbing and I don’t force the needles when there is too much resistance. If the needle doesn 't slip into place after wiggling it around I use a sharp, but usually only for one treatment, after which the buttonhole functions again. For the last couple of weeks I noticed a greater difference in the pressures between my venous and effluent pressures on the NxStage machine. previously they were within 10 numbers of each other, but the effluent number began reading 30 to 40 numbers higher. Today, I again had to start new buttonholes and the numbers are back to being close again. So, my first question is what can I do to make my buttonholes last longer? My next question is, does the disparity in the numbers between the venous and effluent pressures indicate anything? Also, I have tried using shorter needles, as you have suggested, but have only been able to find them with short lines. My fistula is in my upper arm and I find the shorter lines are too awkward to use on my own.

With your high venous pressure it sounds like you have a stenios above your venous site. Check with your surgeon, and when was the last time that you had a fistulagram? Know on to the buttonhole lasting only 3 months before you have to change and do new sites. All the buttonholes that I have been involved with I have never come across this problem. First let me ask you do you use touch cannulation? What angle are you going in at 20 degrees are higher,?.
It is ok to use a sharp needle once in a while if you are the one cannulating yourself, but if there is multiply cannulators involved no. One other thing that you might try is placing your arm on a wooded TV try and cannulated using the try; this gets you closer to your buttonhole site and puts the arm on a stable platform Let me Know how it comes out but it appears you have stenios

[First let’s address the high venous pressure. Do you have a stethoscope, if you don’t I recommend that you do so, that on a dally base you can listen to your access. By listen on a daily base you will able to tell if there is a difference in the sound. A good one goes woos woos and a bad one sounds like wee wee. I think if you listen to yours above the venous you will hear wee wee. That is because of the high venous pressures which is a good indicator that you have a stenios. Please checks with vascular surgeon are you home dialysis nurse to have a fistulagram. Second it is ok to use a sharp on your buttonhole once in a while just as long that you or the one doing the cannulation the third one how to make your buttonhole last longer in all the years that I have been cannulating and creation buttonholes I have only twice had to start new ones and they were over 5years. Why you have to have new one every 3 months is every hard to figure out. But one of the clues is that you said you have to wiggly to get the needle in, DO Not wiggle your needle to get into your fistula only wiggle to get down the tunnel track and this is very rare that you have to do that, this is what is propyl causing your bleeding around your tunnel track,

i hope this will help you out let know if can the results