Pierre writes:

The sideways angle was pretty easy because my needles are perfectly aligned with the axis of my vein where the needles to in.

Both you and Cathy say you have a sideways angle. Have never seen other patients accesses up close. Do you mean your access curves in such a way that you are making a stick in a horizontal direction?

How do you select the location for the BH tunnels?


All I meant when I said “sideways” angle is simply this: when you go in, you have to go into the existing buttonhole, unlike with a sharp needle that will go through in any direction. So, you have to push and sometimes twirl it in at the same up-and-down angle, and the same side-to-side angle every time. Neither of these angles of entry are very obvious in an upper arm fistula, because it’s both deep and wide, and because the vein zig-zags up there rather than being straight.



Boy Cathy and Pierre I wish I could say I would be ready to start cannulating dad the 1st day we go back to establish the buttonholes. Weren’t either of you afraid of going to far and infiltrating the arm. Or does the blood flash back so you know when to stop?


Heather, I do have a curved fistula, it has one big “kink” in it which greatly reduces the area to stick (without hitting the end of the fistula). You select where to stick with the help of your training nurse and also with logic. It needs to have a nice straight area and you want to try to aim for the middle of the fistula to avoid hitting the walls. Your nurse will help you…

Marty, basically I inserted fairly slowly and prior to the tunnels forming would actually leak a little when inserting the needles, but that way I didn’t infiltrate. I would watch for the flash, not necessarily the leak and then straighten up and finish inserting. Yeah, there is a bit of fear, but even a better feeling of success!! What a high that first needle insertion and feeling of capability!!



Hi Marty

I think I would be more worried about inserting needles in someone else than I am to do my own. No, in all honesty, I wasn’t afraid of infiltrating, if only because I had seen needles go in the same way every time a nurse did it when I was in-centre. I had also experienced infiltration a few times, and so it’s not something I feared at all. Infiltration is more an inconvience than anything else, because it means you have to deal with it before proceeding, and it can easily delay your dialysis in-centre by a half hour or more, as I recall - and of course, it can leave part of your arm black and blue for a few weeks :slight_smile:

I don’t get any flashback at all until my needle is fully inserted and then I pinch the tube near the needle.



When you are establishing BH tunnels, how do you know you are going in at the exact same angle each time? I mean, you want to try to go in at a 25% angle, but what if you are off a little?


All you can do is to do the best you can. It works out. The up and down angle you can only judge visually. The side-to-side angle you judge by putting the tourniquet on (not too tight) and maybe squeezing the site a little with your fingers - so that you can see where the middle of the fistula vein is. Hopefully, you will have created your buttonholes such that they align perfectly with the middle of the vein.


In the MediSystems brochure for BH, it says to stretch the skin when inserting the BH needles, but a self -sticker can not do this minus a helper. So then, does the self-sticker just swivel the needle to get it in?


Think it was Cathy who said that it is a good idea to position the arm at the same angle everytime so the angle stays the same. Do others do this?


You can read lots of things that don’t apply much in the real world - or which only do if a helper is doing it. You only have one hand if you self-stick, so chances are you’re not going to be able to stretch anything. This is where a tourniquet that can be operated with one hand comes in handy. Some of the “suggestions” also depend on the individual fistula. Everyone is different to some extent. For example, you read about how you should go in at a certain angle and then level off when you get a flashback. Well, I’ve done mine straight through since the beginning - no levelling off. I don’t even get a flashback until I pinch the needle tube. It’s been working fine for a whole year.

Yes, I found that not only my whole arm had to be positioned the same way, but even my hand has to be facing up the same way every time. It might not be as critical for a forearm fistula (don’t know, since I’ve never had one), but in the upper arm, a lot changes with arm and hand position.



Hi All,
Just had a few minutes to read this thread. I just started a second set of buttonholes on hubby Ralph in the last week and a half. The first time I did it, it was in center with them watching me. The sharps went in beautifully. From than on we wnt to the center 2 more times so I could be sure everything was working fine. Came home and inserted the sharps.
let the buttonholes scab a little and than went in with the dulls. I did this so we could do nocturnal. We are not allowed to do nocturnal using sharps.
The new sits are working fine. Went to the Neph’s today and he wants us to start a second set. The original ones have now sealed up pretty much and the Venus always hurt my hubby going in. The new sites don’t hurt him at all. So I guess in a couple of weeks I will start another set.
One new thing I learned at the center this time was that the nurses were now being taught to flip the wings of the needle first and then insert. This helps the needle move along the channel much easier. It is alway good to learn something new.
Marty- don’t worrry, It really is not hard to start with sharps.
We also found that using the emla cream softens up the site and the plug comes out much easier.
Thanks to all of you. Knowledge is powerful and knowledge makes life a lot easier to enjoy to its fullest.
Life is GREAT! :lol:


Pat, Just curious if the new sites are working fine what is the reasoning behind having a second set of sites.


I hope you’re not taking your advice for buttonholes from a nephrologist! :slight_smile:

Frig, they know less about that than we do.



Pat wrote:

The new sits are working fine. Went to the Neph’s today and he wants us to start a second set. The original ones have now sealed up pretty much and the Venus always hurt my hubby going in. The new sites don’t hurt him at all. So I guess in a couple of weeks I will start another set.

Are you saying that you had to start two new sites because the orignal venus site was painful? And they don’t want you to use sharps at home during nocturnal…what happens if a tunnel closes up and you can’t get in with a dull needle…is that why your neph wants him to have a 2nd set?

Pat wrote:

We also found that using the emla cream softens up the site and the plug comes out much easier.

Had read somewhere that it is not recommended that EMLA be used once the tunnels are formed. Don’t recall the reason given. Did your nursing staff decide this was an ok thing to do? Glad it is working for you-just wondered what the rationale was.

Pat wrote:

Thanks to all of you. Knowledge is powerful and knowledge makes life a lot easier to enjoy to its fullest.

So true…it is a great feeling becoming empowered, free, no longer dependent for one’s care.


When making a pillow with gauze for the arterial site blood sometimes leaks on the gauze. Is it ok to leave it as is or must it be changed out?


They wanted us to have 2 sets of buttonholes & a;ternate between them for treatments…but they were always healing up too much, with a 4 day gap. The other H.H.D. patients said the same, so most of us now run with just the 2. Occasionally I have a prob. getting one of the blunts in…I have had trouble a few times even so and have used a sharp to open it up, then swap to a blunt. THis is a bit messy, as you can imagine :roll: :slight_smile: , but it gets me going and is better than sleeping with a sharp in! :shock:


I’ve slept with at least one sharp in many times. It didn’t seem to cause any problems.


I have two sets and alternate between them…they do start covering up on the surface after missing two days…however, you can still see the little marks there and what I’ve done is just break open the marks and the holdes are still there…

The first few months its cumbersome getting buttonholes in, takes alot of patience to find those tiny holes…

If you have a hard time getting buttonholes in and use sharps constantly over those buttonholes it can mess up those holes…be careful…

Once those buttonholes mature it will be so easy then…not like the first few starting months…


my fistular is in my forarm and it is pretty curvey. I think from having it for so long, it wasn’t alway that way.

I have one spot where the needle goes in sideways.

No one really showed me how to do it. I was just sitting in the center on night waiting to be put on the machine and got tired of waiting so I just decided to put my needles in. When the tech came over I though he was going to faint. He asked who put those in I told him I did so I would be ready when he got there to put me on. He was all upset you should have waited for some one to be with you and all that.

Most of the techs like to get me on there shift now because I come in and set all my settings on the machine and put in my own needles. I have put my self on the machine a few times and have also been taking my self off and pulling my needles. So they really don’t have to do too much for me when I’m there.

That’s why they figured I would be good with the nxstage.

I plan on using one soon. I just hope I can get a BH going as it is hard enough to keep moving the needles around now at 3x a week I can’t imagine if I had to figure where to stick 6 times a week :roll: