My original fistula “died” with blood clots. Now I need a new one created. Supposedly this is a common occurrence?? I am so debating whether to have one created in my leg (thigh?). The old one is so ugly, 2 giant aneurysms, so ugly. They want to create one in my right arm (I am right handed). So I would have both arms with fistulas…thinking leg would be better. They will not touch the old fistula to remove the aneurysms. Any advice? Thank you in advance.
Checkman, a leg is typically only used for dialysis access when no arm “real estate” is left. If your old has giant aneurysms, chances are the needles were not being placed correctly. Unfortunately, this is very common in-center. As you can see in this image, there are two right ways–and one WRONG way to put the needles in. The wrong way–area cannulation–is used most often, and it leads to aneurysms. These can be repaired by a surgeon.
Yes, it is common for a fistula to fail–but this tends to happen faster when you let other people put needles in it. Please consider getting another fistula in your arm, and then asking a tech or nurse you trust to teach you how to place your own needles. You are the only one on earth who can feel both ends of the needle. It hurts less to put your own needles in than to let someone else do it. And, folks who self-cannulate have fistulas that last for years–I’ve even known a number of them that have lasted 30 or 40 years.
Let me add to Dori suggestions. It is well document that buttonhole’s will last for years without aneurysms, many article cover this. the main problem is infection control. google “a kinder gently way to clean buttonhole sites” we have never had a infection Which has been overcome by the scrubber tecknequine. Also if you don’t use the buttonholes than for all lower arm fistula it is mandatory by me and several others in the field to use the med systems 3/5 cannualtion needle. Why less pressure and decrease the change of infiltrations s
., Gentler Methods for Scab Removal in Buttonhole Access Stuart Mott Harold Moore Q:Is there a better way to remove scabs from a buttonhole access than the use of sharp instruments? A:A viable functioning vascular access (VA) is critically important for patients being treated with hemodialysis, both in-center and home, the VA of choice by the Kidney Disease Outcomes Quality Initiative (KDOQI) is the autogenous arteriovenous fistula (AVF). This access is preferred due to its longevity and lower complication rate (National Kidney Foundation [NKF], 2006), and has led to resurgence in the placement of AVF as the primary access. Comprehensive statistics are available regarding VA complications by such entities as the United States Renal Data System (USRDS) and Centers for Medicare and Medicaid Services (CMS), but there are little data regarding the effect the cannulation technique has on the continued functioning of the access.
Introduction Three basic cannulation techniques are in general use in the United States and Europe: rope-ladder, area, and the buttonhole. The rope ladder, or site rotation technique, is the most frequently used technique, both in Europe and the United States (Ball, 2005). It utilizes the entire length of the access. In the area technique, cannulation takes place in the same general area. This is usually due to ease and speed of cannulation for the cannulater.
Buttonhole Cannulation Technique In the buttonhole cannulation technique, routine cannulation of an AVF is accomplished via the same site and needle path, and was first described by Twardowski and colleagues (Twardowski & Kubara, 1979; Twardowski, Lebek, & Kubara, 1977). Used in Europe for many years (Ball, 2006; Ball, Treat, Riffle, Scherting, & Swift, 2007), it
has gained increasing acceptance and use in the U.S. in recent years, especially in the home dialysis setting. In general, dull/blunt needles are used to cannulate through the scar tissue tunnel tract, which develops via repeated, same-site buttonhole cannulation. Pain and complications, including infiltrations, are reduced (Verhallen, Kooistra, & VanJaarsveld, 2007).
Importance of Skin Preparation Several discussions in the literature report on the importance of skin preparation of the AVF buttonhole site prior to cannulation in hemodialysis. Duval (2010) emphasizes the importance of overall hygiene, such as hand hygiene. Skin preparation by having the patient wash the access arm prior to cannulation was examined (Ball, 2010; Doss, Schiller, & Moran, 2008). Other studies have looked at the importance of following the manufacturer’s recommendations for disinfectant contact time (Ball, 2010), cleaning the site before and after scab removal (Birchenough, Moore, Stevens, & Stewart, 2010), and using antibiotic prophylaxis after needles are removed (Marticorena et al., 2006).
The Clinical Consult department is designed to provide answers to questions concerning clinical problems and to report innovative clinical practices. Readers are invited to submit questions to be answered by a guest consultant. Questions should provide background information and state specific information requested. Answers will be referenced. Manuscripts that address clinical problems or present innovative ideas are also invited. These should be between 400 and 600 words and contain one to three references. Address correspondence to: Charlotte Szromba, Clinical Consult Department Editor, through the ANNA National Office; East Holly Avenue/Box 56; Pitman NJ 08071-0056; (856) 256-2320. The opinions and assertions contained herein are the private views of the contributors and do not necessarily reflect the views of the American Nephrology Nurses’ Association.
Charlotte Szromba, Department Editor
Cleaning of buttonhole sites using exfoliating facial sponges and using antibacterial soap
Australia,Belgium,Canada and USA
DESCRIPTION/ BACKGROUND:
Access infection is the second leading cause of access loss, and infections of all types are the second leading death in patients on dialysis (centers for Disease control (CDC), 2011
The use of pickers to clean buttonhole site has been accepted practice of the development of buttonholes. One of the main problems with buttonholes has been infections. The second is use of instruments that lead to scrapped, ragged, or torn tissue at the mouth of the tunnel track. This can and does lead to the development of wide and loose tunnel mouths. Such trauma to the buttonhole site cause scabs with red and inflamed at the tunnel mouths. In addition trauma develops in large, bulbous scab formation post-treatment. Eventually, as the abuse contains, the mouth increase in size, and the scab becomes concave, which makes it even harder to remove without continued damage to the tunnel. Loose tunnel mouths encourage entry of bacteria into the track, which can lead to infected tunnel mouths and to the formation of elongated and bulbous scabs that are secondary trauma.
PURPOSE AND GOALS: To decrease infections and the development of torn and loose tunnel tracks in buttonholes
METHODOLOGY: Over the last 20 years since the start of buttonholes there has been an ongoing problem with infection in buttonhole tunnel tracks. This has led to a decline in the use of buttonhole method in clinics. The process that has been developed goes right to the heart of this problem. Overcoming the problem with infection and torn and ragged tunnel months is goal.
INTERVENTIONS: In the past we used nothing to clean are buttonhole site, we applied Betadine and waited for it to dry then proceeded to pick the remaining scabs off. After seeing the increase number of buttonhole tracks that were damaged we decided to use exfoliating pads to clean our sites before apply Betadine. An ongoing cleaning process was started using multiple patients, over a two year period of time.
RESULTS: This is the results 60 month follow up to the initial study as you can see in the photos in that there has been no development of any red inflamed torn tissue elongated scab formation. To the contrary the sites are in the same condition as when started. It should be noted at this time there is no problems associated with this method. However at any time that the access looks like there is some type of reaction discontinues use immediately. Started in June of 2009 with two patients’ and know with over 50 we have reached a point of 54,094 cannulation and no infections
. The lowest that has been is a study done by Linda Ball, Sheila Doss, Brigitte schiller, and John Moran reported is (1) Overall results indicated an infection rate of 0.16/1,000 patient days in the in center setting and 0.19/1,000 patient days in the
Home setting.” One infection in an in center patient resulted in death. Although these rates are low,
Infection is a serious
Complication in the hemodialysis population and can lead to fatal outcomes”
Cleaning of buttonhole sites using exfoliating facial sponges and using antibacterial soap
Australia,Belgium,Canada and USA
DESCRIPTION/ BACKGROUND:
Access infection is the second leading cause of access loss, and infections of all types are the second leading death in patients on dialysis (centers for Disease control (CDC), 2011
The use of pickers to clean buttonhole site has been accepted practice of the development of buttonholes. One of the main problems with buttonholes has been infections. The second is use of instruments that lead to scrapped, ragged, or torn tissue at the mouth of the tunnel track. This can and does lead to the development of wide and loose tunnel mouths. Such trauma to the buttonhole site cause scabs with red and inflamed at the tunnel mouths. In addition trauma develops in large, bulbous scab formation post-treatment. Eventually, as the abuse contains, the mouth increase in size, and the scab becomes concave, which makes it even harder to remove without continued damage to the tunnel. Loose tunnel mouths encourage entry of bacteria into the track, which can lead to infected tunnel mouths and to the formation of elongated and bulbous scabs that are secondary trauma.
PURPOSE AND GOALS: To decrease infections and the development of torn and loose tunnel tracks in buttonholes
METHODOLOGY: Over the last 20 years since the start of buttonholes there has been an ongoing problem with infection in buttonhole tunnel tracks. This has led to a decline in the use of buttonhole method in clinics. The process that has been developed goes right to the heart of this problem. Overcoming the problem with infection and torn and ragged tunnel months is goal.
INTERVENTIONS: In the past we used nothing to clean are buttonhole site, we applied Betadine and waited for it to dry then proceeded to pick the remaining scabs off. After seeing the increase number of buttonhole tracks that were damaged we decided to use exfoliating pads to clean our sites before apply Betadine. An ongoing cleaning process was started using multiple patients, over a two year period of time.
RESULTS: This is the results 60 month follow up to the initial study as you can see in the photos in that there has been no development of any red inflamed torn tissue elongated scab formation. To the contrary the sites are in the same condition as when started. It should be noted at this time there is no problems associated with this method. However at any time that the access looks like there is some type of reaction discontinues use immediately. Started in June of 2009 with two patients’ and know with over 50 we have reached a point of 54,094 cannulation and no infections
also it is important to lift weights to devolve and maintain fistulas. Use a 5 pd weight lower the weight between your legs and do curls as many as possible to force blood down and increasing the size of the vessel. After dialysis do the same thing this acts like a flushing of the fistula to minimize clots and kept a good flow through your access