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.