Sharp needles for button hole?

I am on HD for 16 months. I am convinced that buttonhole method is better. My clinic only practice step ladder needling.
I collected all info from various websites and got started buttonhole method in December 2005. I purchased my own blunt needles, but was not permited to use them and said no protocall?
I am still using sharps as I have no choice.
Can some one tell me what can happen if I continue to use sharp for my buttonholes on a long term. So far I do not have signs of any trouble.
I believe buttonhole needling was invented 30years ago in Poland, I wonder when was special buttonhole needle invented?

Skai

[quote=SKaiSeow;12910]I am on HD for 16 months. I am convinced that buttonhole method is better. My clinic only practice step ladder needling.
I collected all info from various websites and got started buttonhole method in December 2005. I purchased my own blunt needles, but was not permited to use them and said no protocall?
I am still using sharps as I have no choice.
Can some one tell me what can happen if I continue to use sharp for my buttonholes on a long term. So far I do not have signs of any trouble.
I believe buttonhole needling was invented 30years ago in Poland, I wonder when was special buttonhole needle invented?

Skai[/quote]

Oh no, don’t use sharps for buttonhole needling…you will damage it after sometime…you have the right to use your buttonhole needles so fight your way to use buttonhole.

I use my own buttonholes while in hospital…you tell your clinic about this website and also talk to your Dr. that you insist to use buttonhole…its your right…

If they don’t, consult with a lawyer…

[QUOTE=Gus;12911]Oh no, don’t use sharps for buttonhole needling…you will damage it after sometime…you have the right to use your buttonhole needles so fight your way to use buttonhole.

I use my own buttonholes while in hospital…you tell your clinic about this website and also talk to your Dr. that you insist to use buttonhole…its your right…

If they don’t, consult with a lawyer…[/QUOTE]
Hi Gus,
Thanks for your advice I shall see how I can approach this problem with out stepping on any toes.
Take care.

try first without stepping on toes, but if you have to mash a few, go ahead.

[QUOTE=SKaiSeow;12910]I purchased my own blunt needles, but was not permited to use them and said no protocall?
I am still using sharps as I have no choice.[/QUOTE]
I take it that you’re still in a center, Skai? Are you thinking about going home? If you do, the center staff won’t have any control over which needles you use. As far as using blunt needles in center, who have you talked to about it? Have you tried the nurse manager? I would be very happy to put that person in touch with the leading U.S. Buttonhole experts if it would help to update the policy at your center. Ideally, all centers would encourage self-cannulation and help folks learn how to do it, and would encourage the use of the Buttonhole technique for fistulas. Done correctly (using a sterile, disposable tweezers to remove the scab), this technique is a safe and effective alternative to the rope ladder technique. If it helps, the Buttonhole technique is described in the Vascular Access module of the new, 3rd edition of the Core Curriculum for the Dialysis Technician, a training manual that you can download from the Medical Education Institute website at http://www.meiresearch.org and bring in and show your care team…

Can some one tell me what can happen if I continue to use sharp for my buttonholes on a long term. So far I do not have signs of any trouble.

Unlike Gus, I don’t think it will necessarily cause any problems. The biggest risk is if you don’t go in at exactly the right angle and you start cutting a new channel next to the old one. If you are the one cannulating yourself, you can mostly prevent this, but it could happen.

I believe buttonhole needling was invented 30years ago in Poland, I wonder when was special buttonhole needle invented?

The Buttonhole technique (“constant-site” cannulation) was invented in Poland by Dr. Zbylut Twardowski. I emailed him and asked him your question about when the special needles were invented, and he told me that originally, the Buttonhole needles were blunter because they were reused. In the U.S., in the 1980s, he found that the nurses were having a harder time doing the Buttonhole because the needles were not reused here, so they were always sharp. Some time in the early 1990s, he talked with MediSystems, who began to make needles that were somewhat blunt (they are more blunt now). Today both MediSystems and Nipro make a needle with intermediate sharpness. Thanks for asking!

[QUOTE=SKaiSeow;12910]I am on HD for 16 months. I am convinced that buttonhole method is better. My clinic only practice step ladder needling.
I collected all info from various websites and got started buttonhole method in December 2005. I purchased my own blunt needles, but was not permited to use them and said no protocall?
I am still using sharps as I have no choice.
Can some one tell me what can happen if I continue to use sharp for my buttonholes on a long term. So far I do not have signs of any trouble.
I believe buttonhole needling was invented 30years ago in Poland, I wonder when was special buttonhole needle invented?

Skai[/QUOTE]
Thank you all for the great responses I am getting I do appreciate you kind people.
I am a Singaporean and not living in USA. My home is in sunny Singapore, and hope you have heard of our tiny Island Republic.

We are like a little United Nation with many nationalities living here from all over the world. We have great restaurants serving food from every corner of the world. Over 4 million people living on this Island. Please read more about Singapore in the www.

I started HD in Nov 2004. Yesterday was my 222 nd. dialysis treatment at the NKF Singapore. I started to educate myself by reading the various websites mostly from the USA. I learn a lot from it and thank you
.
When I started HD, I suffered may problem of carnulation, stenosis, infiltrations and so on. At one stage I had fobia going for HD not knowing what to expect. It is like betting in the casino.

I stumbled on the constant site buttonhole technique and ask my center about it. I was told no center in Singapore is doing this and they are looking into this. Not convinced, I visited a few other centers to confirmed this fact.

I am on 3xweekly in center HD. After reading the instructions and watching vedio clips on the web, I started buttonhole with a friendly/helpful nurse. What I did was considered unofficial.

When the center evtually found out about 3 weeks later, nurse in-charged and Doctor i/c. they tried to stop me and insisted I should go back to conventional step ladder system.

I protested violently and after signing an indemnity letter I beg them to let me continue.

As they do not carry blunt needles, I got them supplied by the local agents, Nypro Buttonhole needles.

As I was the first patient asking for them, they delivered 100 needles to me no charge.
I brought some down on my next visit and requested them to be used on me instead of sharps. The nurse said she needed to get approval/clearance from higher authorities.
A week later the charge nurse said that my request was not approved.

My intention was to commence self needling with the buttonhole blunt needles as it would be safer for me to start learn self sticking. I have not started self-needling yet but hope to start as soon as I can get clearance to use the blunt needles.

There is still no dates from my center as to when the NKF Singapore will introduce “constant site” needling, I begin to worry, will the sharp needles cause damaged to my AV fistula? I then posted the thread on this forum.

I hope you will share more of your experiences

Skai.

NxStage Portable HD Machine.
I read with great interest the mobile NxStage portable dialysis machine. I wonder when will such machines be available is Singapore?
I would love to be the first person to be on that machine in Asia.
I would like to purchase the machine as soon as passible.

I am in Canada and here we can do blunt needles. I do hemo at home and 99% of the times I use blunts which give me confidence that I won´t damage my fistula. My 2 cents worth is for you to write a letter to the Health Authority and present your case…and ask for a written reply explaining you why you are not allowed to do it. Is your body, right?

Dori
where do you get disposable tweezers?..I use metal ones which i clean with alcohol very carefuly. I clean them before and after using them…they are very pointy…:confused:

[QUOTE=jedimaster;12934]Dori
where do you get disposable tweezers?..I use metal ones which i clean with alcohol very carefuly. I clean them before and after using them…they are very pointy…:confused:[/QUOTE]
I mentioned the sterile disposable tweezers on purpose, because a few reports are starting to come out about people getting fistula infections using the Buttonhole because they’re not careful enough about how they remove the scabs. Since scabs contain skin bacteria (they form after dialysis, when your arm is no longer clean), breaking them into pieces and then pushing a fragment into your fistula can introduce bacteria where it doesn’t belong. Sterile disposable tweezers are for one-time use only, so you can help prevent infection. Janet Holland, RN, a Buttonhole expert, recommends these in her talks. (She has one story about a fellow who removed his Buttonhole scabs with a toothpick he’d had in his mouth. The resulting infection was not good.) I’ll email her and ask her where she gets them.

In the meantime, I put sterile disposable tweezers into Google & found some sources. One place offers them for CSI-type police work–10 pairs for $5.95, or 59.5 cents each. http://shop.armorforensics.com/mm5/merchant.mvc?Screen=PROD&Store_Code=RedWop&Product_Code=3-5218

Hi Skai,

This is Kamal, a 31 year old male from India. In India too nobody uses the buttonhole method. When I read about it on the internet, I talked to my doctor and the dialysis staff at the centre that I went to for dialysis. There was a mixed response.

But I managed to start using it. Now I’m doing daily nocturnal home hemodialysis and I have a dialysis tech coming home to do my dialysis. We are using buttonholes with needles from Medisystems which I got from the US.

In countries like ours where newer methods and techniques have not yet arrived, generally doctors are a little sceptical to try out something new.

But I have found that if the patient has read up on things and is in the know of things, it really helps. Doctors talk to you with more respect and value your judgement.

Al the best!

Since tweezers are a necessary part of the tx, it seems Medicare should cover just as it does other supplies. My nurse instructed me to use sterile needles for scab removal. I know I read somewhere else that this should NOT be done. Probably Medicare does not pay for one use tweezers or the supply company would be supplying them. Anyone getting them through Medicare?

There is a scab to be removed, but also, the needle helps to open up the area as sometimes it is difficult to know where the opening is and I find the needle helps. I am for good practice. Have not had any infections after preparaing the sites well, but am always ready to learn if the technique I was instructed to use is not safe.

I bought a very pointy set of stainless steel tweezers which I boil for at least 5 mins and then soak in chlorhexidine. I resoak it for each scab.I find the sharp little needles (19g) very useful to make the initial dig at the scab to lift it and then use the tweezers to take it off cleanly (most of the time) Sometimes it is easier than others though.

[quote=Gus;12911]Oh no, don’t use sharps for buttonhole needling…you will damage it after sometime…you have the right to use your buttonhole needles so fight your way to use buttonhole.

I use my own buttonholes while in hospital…you tell your clinic about this website and also talk to your Dr. that you insist to use buttonhole…its your right…

If they don’t, consult with a lawyer…[/quote]

Gus,

If the angle is consistent how do sharps damage the fistula? I’m almost on a year now with these buttonholes and I rarely use blunts because they don’t seem to pass through the second wall. Rather than fish and push and fish and push, my sharp hits the mark every time. My fistula is fine. I can understand how I can damage if I’m outside the track, but if not where does the damage occur?

Thanks for the info, Erich

[QUOTE=jedimaster;12934]Dori
where do you get disposable tweezers?..I use metal ones which i clean with alcohol very carefuly. I clean them before and after using them…they are very pointy…:confused:[/QUOTE]
I do not use tweezers at all. I remove scarb by lightly scrubbing them with bath sponge and soap under running tap water at bath time.

Hi to all you successful button hole practitioners.
Thanks for sharing your experience. I have the Nypro button hole needles. I intend to start self needling soon at the center.
Can you tell me how you feel the first time you change to blunt needles? Do you need more force to inseart them as compared to sharp ones?
When do you plan to self needle?
As I plan to do lots of travelling, and will have dialysis all over the world. It would be less stressful for me to know I can needle myself.
Take care.
Skai.

[quote=TheRiverdude;12955]Gus,

If the angle is consistent how do sharps damage the fistula? I’m almost on a year now with these buttonholes and I rarely use blunts because they don’t seem to pass through the second wall. Rather than fish and push and fish and push, my sharp hits the mark every time. My fistula is fine. I can understand how I can damage if I’m outside the track, but if not where does the damage occur?

Thanks for the info, Erich[/quote]

The sharp will cut anything and every edge of the tunnel resulting with wider/bigger holes. The probablity of damaging is high, reason for that is because the tunnels move after sometime…once you make a mistake that’s it, its damaged. It will leak and even affect pressures. Keep doing for sometime and you will see… sometimes I’ve taken up to 15min just to find the tunnel, now and then they move…

I clean my tweezors with alcohol before and after each use…but I will ask my team to see if we can get disposable ones for all home users!

This thread is of particular interest to me as I used to always ask Epoman for advice on buttonholes and now I can’t. So I will be here a lot more. Hope that is okay. I have been trying to establish buttonholes since Dec 8th 2006. I have NEVER had the same nurse more than twice in a row right from the get go! This upset me because I read that there should be the SAME cannulator for at least the first 6 times (2 weeks)!! I have told them this and I have printed out the page I was reading with diagrams of how to establish and how to cannulate after it is established, and they don’t want to look at it saying they have done this for 20 years. A lof of them seem to feel that as long as they get you on the machine and you get good kt/V that is good enough! But it is MY arm and I want this fistula to last a long time! I am only 33 and have been on dialysis for 6 years (Hemo only since July of 2005). My fear is that they will ruin my fistula! I am not on home hemo as I live in a building where I can’t alter the plumbing and since I am in Canada I can’t get NxStage.

With the buttonholes, the nurses (we don’t have techs here, the nurses do everything) still can’t seem to cannulate me successfully. If the nurse Becky who started my buttonholes isn’t available the nurses don’t like to try my buttonholes with a blunt for too long and give up too easily and use sharps. This upsets me as I worry they will ruin it. I know my buttonholes work but that the angle is odd. My Arterial usually isn’t a problem but they had to use a sharp last Wed on it. Usually the Venous one is difficult because it lines up on a dip in the fistula. I have to actually hold the fistula so it doesn’t roll at the same time as pull back while the nurse cannulates me. How in the world would I ever be able to cannulate myself?? Especially if the nurses can’t even cannulate me using both their hands!

Any advice anyone can give I would love but particularly my worry about them resorting to sharps in the buttonholes is why I have posted here. I just wanted to share my story.

Thanks Dori for the link! I use tweezers as well as the sharp needle in the red package to pick off the scab. I use the needle as it is sanitized and the tweezers only to pull off and away so I don’t encourage infection. Thanks for all your advice to everyone! It is very informative!

Angie, we’re certainly happy to have you here, and glad to help with your buttonhole questions, since those are related to home dialysis (the topic we try to stay on, here).

My best advice to you would be ask your nurses to teach you how to put in your own needles (even using the rope ladder technique, if need be). Once you can do that, then you can start your OWN buttonholes–and since you would always be the consistent person putting in the needles, I think you’ll find that it will work better than relying on someone else. It’s just not practical in most centers to be able to assign one consistent person to put in needles, even for just a few weeks.