First of all welcome!..

To answer your question yes! It has hapened to me before and after discovering the cause I have minimized it greatly…here’s what I’ve found in my experience…

  • Arterial or Venous needle gets stuck against the wall…
    Solution: Move them a bit till they stop touching the walls and place a 2x2 folded twice under the needle, works best before starting treatment

…if that fails, do a saline flush…just 100…now if it still continues going up check dialyzer for very dark, almost black look…if it looks okay then continue with needles…one of the needles may have clotted a bit and you may need to re-insert a new needle…

…however, one way to prevent these situations is to prepare yourself ahead…

one way is after inserting first buttonhole flush it out with 10cc syringe filled with saline, keeping it clear of blood…that way the first buttonhole doesn’t clot up…that way placing your 2nd buttonhole may take time…


If the pressures aren’t stable and almost always about the same, then the most likely scenario is that the tip of the needle is not in the centre of the vein. It’s touching or very close to the wall of the vein. In addition to altering the flow into the needle, it will also make your fistula spasm, plus every time you bend your arm a bit during the treatment, this tip of the needle will touch the wall even more, sending your pressure out of limits and triggering an alarm.

If your upper arm fistula is anything like mine, everything changes if your arm isn’t held exactly the same way each time you are putting a needle in. I have to make sure I alway hold my arm out straight, and my hand palm up. Otherwise, even if I can get the dull needle in, the angle won’t be the same.

Yes, getting the scabs off can be difficult. Sometimes there really isn’t a scab. Don’t dig for it. If there isn’t a scab on the surface, just break the entry point a bit with the tip of the syringe needle you are using. This will ensure the dull needle goes in at the right spot exactly. If you draw blood, sponge it off with a gauze so you can clearly see your entry point (I then use an alcohol swab just to ensure it’s clean).

It doesn’t sound like I’m using exactly the same procedure as some others on this forum. I’m not sure what Gus means. My needles are already connected to a 20ml syringe and already flushed before I put them in. Once a needle is in, I tape it, and then pull blood up and then push it back down, leaving a couple of ml of blood at the bottom of the syringe. Flushing this way will prevent clotting of one needle while you put the other one in, and until you start the treatment. By pulling up blood hard for the arterial and pushing it down hard for the venous, it also helps to ensure you’ve got it in right. I’ve never had a needle clot.

By the way, how you tape the needle down is also going to affect pressures. I use Tegaderms, not tape - because I do nocturnal hemo (so it has to be very secure). However, no matter what you use, you have to be sure you’re not taping down so tight that you are changing the angle of the needle. SOP for me is a 2x2 gauze folded over in half and stuffed under the needle before I tape it down. In fact, I started out with one gauze, but I soon realized I need two of them under each needle. Upper arm fistulas can be fussy like that, because the vein is deep.

And finally, fistulas can change over time. In my program, they have us come in about every 6 months or so to do a short daily treatment in-centre so they can do a Transonic on the fistula. As a matter of fact, I have to go in this morning, so I had better start getting ready :slight_smile:

Good luck.



Don’t you usually flush your needle line with saline as a matter of course? :shock:


Yes, of course! :wink:

BUT…I do after the needle is in…I don’t like the syringe dangling at the end while concentrating on putting in my needles… :arrow:


Definitely ditto! 8)


Of course as always, it seems I was trained differently. I do not flush my needles at all when I insert them. If by any chance one clots, I am trained to use a syringe and pull the clot out and then keep going, taking out the needle and reinserting it would take forever!!

With regard to pressures, if would first untape it and move it around to see if the pressures go down. If they do I retape. I would also try a “pillow” (a gauze folded up and inserted under the needle to change the angle). I have one buttonhole that has to have a pillow the others don’t.

I use a tweezer to remove my scabs and it works well. I always keep it in alcohol to make sure it is clean. Do try not to remove them prior to treatment as then it just kind of closes over and you have to “break through”.

I also agree with Pierre that my arm position is very important in inserting my needles, sadly I didn’t know this originally so I have three different arm positions for 4 buttonholes, but at least now I know them. An as he says, even how you hold your wrist is important.

Hope this helps.



I will be going in 2 months with dad so his button holes can be created and start learning to cannulate. Your post make it sound like a very frustrating event. Cathy are you the one who leaves the needles in a little while after you get off the machine?


It’s really more of an art than a science :slight_smile:



Marty is your Dad starting to self-cannulate?


Hi - just wondering: Are you doing the cannulating? your husband? and which machine? In theory it could be a coincidence that the arterial/venous pressures changed when you switched to dull needles - it could be the machine.

I use the 20 gauge needle on my saline syringe to remove the scabs by patiently scrapping from all sides. Like Pierre said not all scabs are equal, are yours always the sametype?

When my pressures are too high (low) at a 350 pump speed I’ll turn the pump down until I am satisfied. Also watching how the pressure reacts when I adjust the pump speed is informative. Are pressures steady and ramp up in proportion to the pump speed? or is there a disproportionate jump at some point?

Sorry for all the questions but I have found that often there are clues when the pressures are out of whack – happily there almost always seems to be a solution - and as others have written it would be interesting to hear the details of what you’re doing now and what you’re feeling/sensing when the machine shows the pressures out of their normal range.


Bill, Dad won’t be doing it. I will. He is 81 and although he can still see his vision isn’t the greatest. So come April 1st I will train to do it.


Marty, I wouldn’t say too frustrating, they worked and then didn’t worked and then didn’t, took me too long to figure out that keeping my arm and hand in the same position was the key. I haven’t had trouble since remembering that.

I wouldn’t have anything but buttonholes, they are so great, so don’t let little things turn you off. I also starting buttonholes and self cannulating on my first day of dialysis, you’ve been sticking your dad for years, my bet is that you will be a pro with buttonholing.

I do leave my needles in for a couple of minutes after I get off, I think it is a nocturnal patient who sometimes gets off and then goes back to sleep before removing his needles. I only leave mine in long enough to drain the dialyzer, and start the acid rinse.

Happy to answer any more questions, and didn’t mean to scare anyone about buttonholes, even when having trouble all I did was switch to a sharp.



Cathy, The problem is I haven’t ever stuck dad. When we first went nocturnal everyone was required to use a catheter. The center thought it safer. Then they switched to the fistula and 2 to 3 years ago a vascular surgeon told me dad didn’t have good enough veins for a fistula. We used the catheter 5 years then dad got an infection. Went into the hospital and they did vein mapping and decided they could create a fistula. So as of September 2005 dad has had the fistula we just haven’t used it yet. The last visit to the surgeon he ok’d it’s use. So we have an appointment set up April 1st at center to start creating the buttonholes. I don’t know if I can do it but I do know I have got to do it. Guess I was just hopeing once I used the button holes everything would be hunky dory.


Marty, it will be hunky dory, I promise. You know all the tricks now!! I can’t say enough how happy I am with buttonholes, even when they gave me a bit of trouble all I did was switch to a sharp using the same buttonhole site, I didn’t fuss much. It takes me only 3-5 minutes to insert my needles and tape down, so quick and so easy.

Take some deep breaths and just do it as the commercials say lol!!



Did anyone read the post at another group where a buttonholer said she found that when the dull needle doesn’t want to go in, she found that by streteching the skin taught she is able to guide the dull needle in which has solved the problem for her?


Didn’t read that post… but its something I do occasionally…just never mentioned it here…c’mon, do women stretch their earlobe skin to get the earing in? It’s common sense…I think everyone pulls, stetches, and rubs to some extent… :lol:


I stretch mine when I’m trying to get the scab off, but not when putting the needle in. The tourniquet already stretches it out.


The point the poster was making, I sense, is that by not holding skin too taut or too loose she finds the direction of the tunnel and that is all the problem is.


Couldn’t agree more with Cathy’s post about how great buttonholes are.

Being fairly new to dialysis I found the challenge of working out where to put the needles in each time was on my mind for hours before I did it and the mental hurdle of breaking new skin was something else!

Buttonholes are fantastic! No more stress or misses and bruising. Worth the initial effort and I love 'em! 8) 8)


It’s not too hard to put sharp needles if the fistula is large. However, those of you who are fairly new on dialysis probably have not had the experience yet of stepladdering all over and back on your fistula for month after month, year after year. You can only keep going over the same area for so long before it’s all scar tissue and it develops into an aneurysm. I had one of them for each needle after a mere two years on hemo in-centre. You can’t really stick needles in an aneurysm, and eventually, you just run out of room on that original fistula. Luckily, by the time I started home hemo, I still had a little room left to create two buttonholes.

So buttonholes are a very good solution to this problem. They aren’t perfect, and some days or nights, you’re going to have problems getting the needles in. Sometimes, no matter what you do or don’t do, the buttonhole tunnels heal enough that the dull needle just won’t go through (your arm isn’t quite like an earlobe). Some days, you will have trouble getting the scab off, and you might chew up the entry point to that buttonhole if you’re not very careful. Sometimes it will be frustrating, especially the first few months… so I wouldn’t have any illusions about that. But it’s still by far the most practical way of doing hemo at home with a fistula. It promises to keep your fistula usable for many years, hopefully as long as you will need it, plus, you won’t have to deal with the occasional poke through the other side of the vein and the resulting infiltration. It’s one thing to have that happen in-centre with a nurse to look after you, but it would be a real hassle when you’re trying to get yourself on at home.

By the way, I started using a betadine gel on my buttonhole after treatment. I just apply it to the gauze. It helps prevent infections, but more importantly for us home users, it seems to create a softer scab that can be removed more easily next time.