OMG, freckles are all over face but none on access which is an upper arm transposition of the brachio cephalic. It’s very shallow but does have it’s dips, especially at the top. The heck with anesthesia, I’m going to need valium lol, or perhaps a few shots (I’m talking alcohol not needles). I’ve never used Emla or anything else. My theory right or not is that I want to know when something is wrong, however the Emla only numbs surface layers anyway. It only hurt when they first started using it five years ago… It’s true about the unit; the same person starts the buttonhole but then others stick… It didn’t sound like such a great idea to me either, but what do I know? Lin.
Amba
It was such a joy for me to stop using any local when I started buttonholing. Saved time and effort. I realised that those little local needles were hurting as much as the big suckers. I can’t imagine poking around inside the hole to stick in some local and then sitting around waiting for it to work. If you are just doing that to stop the bleeding, what bleeding? Taking of the scab cleanly doesn’t seem to create any or much blood at all for me. Maybe yours are different.
I can vouch for Pierre’s “freckle theory”. Works for me! :lol:
When I go to buttonhole method will try it with and without Emla. I have used Emla every tx in-center and it has been a lifesaver for me (co. is not paying me to say this 
) I have heard others say it is not necessary to use a numbing cream after a time as scar tissue builds up and there is little feeling, anyway. But on a couple of occassions I did not get to use the Emla and the sticks hurt and felt sore in my arm the whole tx. I guess the moral is everyone has a different pain threshold.
Thanks for the answer on when to apply the Emla, Pat. It is a great product and I can see how it would soften the plug for removal and make the insertion go well.
Let’s see. Before using the Buttonhole Technique for a treatment, you remove the scabs from previous needle insertions with tweezers, using aseptic technique. Then you cleanse the sites with betadine. Then you insert sterile needles. So, where are the “bacteria and viruses” coming from? This doesn’t even make sense, IMHO. I think this is someone who doesn’t like the technique and is trying to scare people away from it.
Done correctly, the Buttonhole Technique is safe and effective. The Fistula First program is encouraging data collection to better demonstrate its benefits, but in the meantime they’re supportive of it.
Executive Director
The Medical Education Institute, Inc.
http://www.KidneySchool.org
Replying to this old thread, I would like to know if others can add to this list of precautions one should take to avoid an infection using the buttonhole technique with a fistula- the dos and don’ts, if you will, of self-cannulating, or being cannulated by a caregiver, with the BH technique? I would especially like it if those of you who respond can address:
-
Is using gloves and masks with this technique done at home a requirement?
-
Should fans and ac/heating be turned off or vents closed?
-
Should visitors not come in during put on and take off?
Dori, maybe you have an expert, or two, who can give us solid info backed up by authoritative sources?
[QUOTE=Jane;17044]I would especially like it if those of you who respond can address:
- Is using gloves and masks with this technique done at home a requirement?[/quote]
I asked one of my go-to cannulation experts, Debbie Brouwer, RN, CNN, and here’s what she said:
"The best infection control measure is proper skin prep, scab removal, re-skin prep and needle insertion. Wash the skin with soap and water then use the proper cleaning agent, scab removal that doesn’t cause trauma to the buttonhole site and the surrounding tissue (don’t pick off the scab with any needle or anything sharp especially don’t use the dull needle to pick the scab and then insert for dialysis), re-prep the with the cleaning agent and then insert the needle. The use of gloves can help prevent blood contamination from the needle insertion on bare skin to be transferred to your dialysis machine or supplies. Gloves should be changed if contaminated by touching anything considered unclean or after any part of the cannulation and treatment initiation or termination (holding patches) when blood can be on the gloves even if you don’t see the blood. The use of gloves is a unit specific issue. If they are not supplied for home treatments, hand wipes should be used any time gloves or a change of gloves would be used.
The use of masks is a different issue. The KDOQI Guidelines call for the use of aseptic technique for cannulation and to access dialysis catheters. Here is the link to the full text of Guideline 3 http://www.kidney.org/professionals/KDOQI/guideline_upHD_PD_VA/va_guide3.htm The use of masks for dialysis procedures is based on the high rate of nasal staphylococcal carriage in dialysis patients (due to exposure to hospitals or healthcare settings as well as a impaired immune system). Staph is a common bacteria that lives on our skin and in our nose (both patients, staff and family members). The mask prevents the bacteria that lives in the nose from dropping on to the vascular access. Face shields worn by dialysis unit person protect from blood or fluid splashes, but don’t prevent bacteria from leaving the nose and contaminating the vascular access. If the patient or caregiver is a know staph carrier on the skin or in past blood infection- the nose is mostly also a site for the staph to live. It is difficult to kill the staph from all areas of the body including the nose and leads to chronic staph carriage in the person. A mask worn by the patient and caregivers for any vascular access procedures as well as anytime the blood line is opened, can help protect the patient from a staph infection."
- Should fans and ac/heating be turned off or vents closed?
“This is something some PD patients do to prevent infections with PD exchanges. I am not aware of any studies looking at this issue for hemodialysis. I would defer to an infection control expert on this issue. I am aware of issues with infections linked to poor ventilation or ventilation systems contaminated with bacteria or virus.”
Should visitors not come in during put on and take off?
“Visitors present during put on and take off procedures are at high risk of a blood exposure. Visitors can also be nasal carriers of the staph bacteria. I would recommend if a visitor is in the room during put on or take off- they use universal precautions of a mask, eye protection, gown and gloves so they are not exposed to blood and can’t spread any nasal carried bacteria to the patient. If most cases the visitor can just leave the immediate treatment area during the higher risk of exposure time and then return when the dialysis is fully started or after the bloody set up is discarded and the treatment area is cleaned up. Think of a young grandchild visiting a grandparent during dialysis- if the grandparent has an unknown hepatitis C infection and the grandchild is exposed to any blood and then contacts the blood to their mouth – the child could get hepatitis. If the child waits and visits once the dialysis is started and the treatment area is clean from any blood that spilled with the needle insertion or bloodline connection – then the child is not exposed directly to any blood that might cause an infection.”
I’ve never had an infection; no LARGE exit site…just two small insignificant button hole scabs.
Home Dialysis 6xweek for the last 9 years.
A Traveler
P.S.
I never use gloves, alcohol, iodine, masks etc…nor do I let anyone else touch my supplies, arm, equipment so it is only my germs…and I’ve been 100% infection free. But each to his own level of precaution.
Bighoobajooba has posted a lot on an MSN group that used to be run by a dialysis nurse but is down presently due to MSN groups moving, and I was surprised to see that post. I can understand concern but I did a lot of research before trying to get my own buttonholes established and have found through my findings that buttonholes are better. I just couldn’t get any established because my nurses (don’t use techs for cannulation in other countries and I am not in USA) were on rotation and it is recommended to have the same cannulator for the first 6 times. I only was able to for the first 2. This was when I started to realize the importance of learning to self cannulate. I still stand by that buttonholes work if done properly. The problem is that sadly not enough staff know how to properly establish buttonholes on a patient and how to recognize signs of any problems with the fistula itself. .
Not quite sure which post you’re replying to, Angie. Personally, I think Buttonholes are best–at home or if you self-cannulate in-center. When a rotating bunch of staff people all try to use someone’s Buttonholes, they’re pretty much doomed to fail. But this site is for home dialysis, so we tend to assume folks will be at home. 
My husband has just started In-centre HD and may do Home HD in the future. We are a little worried about cannulation. My husband has a graft as his veins are not big enough for a fistula. I asked about buttonhole technique as if we do do it at home it sounds the easiest way. They told us you cant do buttonhole technique with a graft, is that right?
Yeah sorry, been awhile since I have been back. I was trying to be able to do home hemo at the time so I wanted to self cannulate and I had looked into it. I remember I printed out a page that I got from your site on how to establish buttonholes (www.homedialysis.org/learn/buttonhole/) and they found it useful. I would have thought they knew it all but they seemed to like the information. The intent was that when I was well enough I would be taught at home even though I lived alone but then they said I would never be able to self cannulate with my fistula. I got other opinions online who disagreed however. But now I don’t need to worry about that anymore.
True enough! How is your kidney doing?
Kidney seems stable … working more and more all the time … still not 100% but I guess that is expected with an Acute Tubular Necrosis kidney. :rolleyes: Still I am happy that it is working. They were saying that it might only last 5 years and then back to dialysis but others say that sometimes the slow to work ones last the longest. lol I don’t know. We will see. By the way, I edited my previous post as I see why you didn’t know what I was referring to. I was referring to the original poster of this thread’s quote of what bighoobajooba had said.
Anyway, I am also wondering if buttonholes can be done with a graft. I heard they can’t because buttonholes can only be done with a fistula right? I ask because I see someone else just asked that.
Hi Angie,
Glad to hear that it’s ticking along. 
No, you can’t use the Buttonhole technique with a graft. Elaine started a new thread for that question, so I answered it there.
[QUOTE=Dori Schatell;17048]I asked one of my go-to cannulation experts, Debbie Brouwer, RN, CNN, and here’s what she said:
"The best infection control measure is proper skin prep, scab removal, re-skin prep and needle insertion. Wash the skin with soap and water then use the proper cleaning agent, scab removal that doesn’t cause trauma to the buttonhole site and the surrounding tissue (don’t pick off the scab with any needle or anything sharp especially don’t use the dull needle to pick the scab and then insert for dialysis), re-prep the with the cleaning agent and then insert the needle. The use of gloves can help prevent blood contamination from the needle insertion on bare skin to be transferred to your dialysis machine or supplies. Gloves should be changed if contaminated by touching anything considered unclean or after any part of the cannulation and treatment initiation or termination (holding patches) when blood can be on the gloves even if you don’t see the blood. The use of gloves is a unit specific issue. If they are not supplied for home treatments, hand wipes should be used any time gloves or a change of gloves would be used.
The use of masks is a different issue. The KDOQI Guidelines call for the use of aseptic technique for cannulation and to access dialysis catheters. Here is the link to the full text of Guideline 3 http://www.kidney.org/professionals/KDOQI/guideline_upHD_PD_VA/va_guide3.htm The use of masks for dialysis procedures is based on the high rate of nasal staphylococcal carriage in dialysis patients (due to exposure to hospitals or healthcare settings as well as a impaired immune system). Staph is a common bacteria that lives on our skin and in our nose (both patients, staff and family members). The mask prevents the bacteria that lives in the nose from dropping on to the vascular access. Face shields worn by dialysis unit person protect from blood or fluid splashes, but don’t prevent bacteria from leaving the nose and contaminating the vascular access. If the patient or caregiver is a know staph carrier on the skin or in past blood infection- the nose is mostly also a site for the staph to live. It is difficult to kill the staph from all areas of the body including the nose and leads to chronic staph carriage in the person. A mask worn by the patient and caregivers for any vascular access procedures as well as anytime the blood line is opened, can help protect the patient from a staph infection."
“This is something some PD patients do to prevent infections with PD exchanges. I am not aware of any studies looking at this issue for hemodialysis. I would defer to an infection control expert on this issue. I am aware of issues with infections linked to poor ventilation or ventilation systems contaminated with bacteria or virus.”
“Visitors present during put on and take off procedures are at high risk of a blood exposure. Visitors can also be nasal carriers of the staph bacteria. I would recommend if a visitor is in the room during put on or take off- they use universal precautions of a mask, eye protection, gown and gloves so they are not exposed to blood and can’t spread any nasal carried bacteria to the patient. If most cases the visitor can just leave the immediate treatment area during the higher risk of exposure time and then return when the dialysis is fully started or after the bloody set up is discarded and the treatment area is cleaned up. Think of a young grandchild visiting a grandparent during dialysis- if the grandparent has an unknown hepatitis C infection and the grandchild is exposed to any blood and then contacts the blood to their mouth – the child could get hepatitis. If the child waits and visits once the dialysis is started and the treatment area is clean from any blood that spilled with the needle insertion or bloodline connection – then the child is not exposed directly to any blood that might cause an infection.”[/QUOTE]
Have planned to come back to this thread, but have been pondering the info here. Thanks to you for locating Debbie Brouwer for this detailed response. Additional questions I would have are:
-
If a patient does not wear gloves and a small amount of blood gets transferred to the machine or supplies what harm does this cause?
-
Can aseptic cleanser be used in place of hand wipes?
-
What is the reason a sterile needle should not be used to lift the scab off? Some patients use SteriPiks or tweezers. Others use EMLA cream which either removes the scab completely or leaves a very easy to remove scab which can be gently lifted off with a sterile needle. Any of these tools could tear the tissue if used harshly, but if used gently why would one be any better than the other?
-
Why is it that in most dialysis clinics, nurses/techs only wear masks for catheter patients, but not for patients with arm accesses?
-
Is it possible that some patients are simply more prone to getting an infection than others, because there are patients who have never gotten an infection although they have dialyzed in clinics that were extremely unsanitary where every rule in the book was broken re aseptic technique. Or some patients say they follow some aseptic procedures when self-cannulating, but not others. And I’ve never heard of any home patients who have visitors wear full protective clothing.
-
If a patient dialyzes alone, do all the same rules apply?
-
If patient/caregivers wash hands must they also wear gloves when getting supplies out of the supply cabinet? What is the reason caregivers should wear gloves when setting up the machine and assisting with the tx?
-
When patient/caregivers get supplies out of the boxes they are shipped in from UPS etc. these boxes are not sterile and can be quite dirty at times. The supplies inside may come from unsanitary warehouses and unclean hands of workers may of touched the supplies or the individual boxes they come in. Is this a concern?
Hi all:)
I shall be reading through this thread, and reviewing some of Gus’s vids, as I’ve just been given a couple of weeks worth of blunt needles. Our trust has finally after a few years of suggestion come around to introducing them:)
Loving the forum, after a year + on home heamo it’s as useful as ever:)