It was 12 years of age when I started inserting sharp needles to myself. I was tired of all the un-skilled staff (mostly un-certified) that were inserting needles in me. I finally said to them, I wanna do it! Shocked in awe they dropped their jaws and started calling everyone to see thios 12 year old insert his own needles!
I don’t think you should rely on them for insertion of buttonhole needles. If you do this yourself you will be able to do a better job, you can really feel your arm and where that needle is going.
Hi Angie
Lovely to see you here! I started doing buttonholes around the same time as you (almost to the day) and I am with Gus and Dori, just go for it and try yourself. I cannot imagine how difficult it would be to have a number of other people trying to do it to you. Only you know what it feels like and the different sensations you experience when it goes in well or hits the sides of the tunnel. Mine has moved slightly one direction and then the other but in the end it is a wonderful feeling when you hit home and know that you can do it. No matter how experienced the nurses are it is you that is going through this and can give you the very best outcomes.
Cheers
It is about time YOU start doing your own needling. You have to bite the bullet. It is you and only you who will start using the same force, same angle…same hand. I hated it at the beginning and I was quite afraiid (terrified!)…but I managed.
Once in a blue moon I use sharps because the blunt is giving me grief, but the next 20 times the blunt works perfectly fine.
Now…if by any chance they got into a spot that is not the ¨perfect¨spot for self needling with blunts, then start fresh on another area and start the process.
My point is…BITE the BULLET…you are the one who will make it happen.
[QUOTE=Dori Schatell;13025]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.[/QUOTE]
Thx but as I said … my buttonholes are already started and I can’t ever do them myself because of the reason I already stated:
[QUOTE=AngiesKidney;13024]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![/QUOTE] To clarify … my fistula takes about 3 hands to keep it stable while cannulating it … It rolls all over the place and even using the tournequet is not helping! Any suggestions for keeping a Fistula from becoming snakey?
Sorry if my post was too long.
I understand that it is not practical to assign a consistant nurse to just me now but when I was inquiring about buttonhole they led me to believe that it was possible. I realize now that it isn’t and I feel they should not have led me on about this. It is a huge disapointment. Especially since I have read the extreme importance of having the same cannulator for the first 6 times. How do other people do this?
I am worried that if I move to PA from Canada that I will end up having to have a chest catheter put in instead just to do dialysis as it seems no nurse or tech is able to cannulate my buttonholes successfully … Should I start a new thread about this?
Also to everyone else, I will do it myself when I know what in the world to do! Maybe I should stop using Emla cream. It is effecting how well I feel everything … I realize this … and I know with Buttonholes you are supposed to stop but with them and their fishing around I get in so much pain that I find it easier for now. I want to eventually do it myself but when it is established … which they say mine are not yet. When will they be? No one can tell me!
I think most fistulas roll, Angie, though folks here can tell you more about that. The purpose of using a tourniquet is not to keep it from rolling, it’s to plump up the vessel and make it easier to hit the right spot.
If you download the Vascular Access module of the new Core Curriculum for the Dialysis Technician from the Medical Education Institute website (http://www.meiresearch.org), you can see the 3-point technique the authors recommend for holding a fistula in place while you put the needles in. It has to do with stretching the skin and also anchoring the vessel in place. There’s a drawing so you can see it.
I am worried that if I move to PA from Canada that I will end up having to have a chest catheter put in instead just to do dialysis as it seems no nurse or tech is able to cannulate my buttonholes successfully .
By PA, do you mean Pennsylvania, in the states? So, you might be able to do home hemo?
I have never heard of someone needing to switch from a good (if snakey) fistula to a catheter so the staff can cannulate them. This would be a very bad idea. Either you haven’t had the right staff, or they haven’t been using the right techniques.
I still say that you should be able to do a better job than they can. Just because they have been having trouble (and they’re professionals) does NOT mean that you can’t do it. If you learn how to hold your fistula in place, you can make it work. I’m going to email a few of our favorite cannulation experts & see if anyone can give us some more specific info to help you.
“Stuart Mott & Barb Prowant wrote up a technique called the “Cushion Cannulation” technique in theANNA Journal under clinical consult (http://nephrologynursing.net/ND2006/dept/clinical/default.htm) - she can print the article off. It uses a wheelchair cushion up under the upper arm, which helps to stabilize veins and tissues. Stuart is having great success with site rotation as well as withthe buttonhole technique - basically it hyperextends the arm keeping it in the same position during the cannulation process. Once the needles are in, the cushion is removed.”
So, you may want to print that article and take a look at it; maybe bring it in to your center.
Oh very good info! Thanks Dori! The problem is my Windows went and I am using a CD run copy of Knoppix Linux so I will have to print them out when I redo Windows on Tuesday (was going to do it this weekend but felt rather crappy from fluid overload). Yes, PA I will be able to do home hemo as my fiance owns his own home. The only thing is I would rather him move here as I have FREE health care here and he has no health coverage with his job.
Anyway, yes, anymore info you can find the better! I would love to learn the best technique to do my own cannulation but the trouble is holding my fistula in place as I cannulate. The odd thing is the venous one was the hard one but the last 3 times the arterial is the hard one and they keep having to resort to sharps Thus why I came to THIS thread
Dori,
Have you and Beth ever considered having an “Ask the Experts” type section at HDC? Back in the days of the old DialysisEthics site, a lone nurse singlehandedly responded to patients’ questions. I was one of those patients and she helped me tremendously. I’ve always felt that an ask the experts board is necessary again.
We kind of do that informally through these boards. If folks can’t help each other–often the questions really are ones that others who are doing a treatment can answer–we have a variety of experts in many different areas that we can call on occasionally. (No one person can be an expert in everything.) But we don’t want to overburden them by giving them a regular role. It’s something to think about, though.
I agree with Jane simply because a separate section to “Ask an Expert” would be wonderful as a LOT of people have mentioned to me how they want that but can’t find that in any forum and it used to exsist in one. This forum is one of the best around and I know it would benefit with that. But as it is the layout is so clean and neat already that any questions just get asked in the right section and is easy to find the answer already as it is! Thank you for answering my questions! So many people told me this was the place to ask!
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]
From information gathered, I understand that button hole needling was first use on a patient in Poland due to his difficult fistula many years ago.
At that time there was no special needles available. I was told that Medisystem only introduced special needles in 1990.
I guess you are right as long as the angle at insertion is some what constant it will not cause any harm. For me to start self needling I would try using the blunt after the track has been established by clinic’s SN. This way I feel much safer.
Thanks Eric for sharing your experience.
Skai.
We kind of do that informally through these boards. If folks can’t help each other–often the questions really are ones that others who are doing a treatment can answer–we have a variety of experts in many different areas that we can call on occasionally. (No one person can be an expert in everything.) But we don’t want to overburden them by giving them a regular role. It’s something to think about, though.[/QUOTE]
Dori,
As I said, I really benefited from the Education Board at DialysisEthics. The one nurse who tackled all the patient questions was a brave soul! It was amazing what one person accomplished for so many. But it concerned me that she would become burnt out as the daily questions that came in were too much for one person to handle. I actually was the person who suggested the Education Board and the education provided there supported me and saved my life on more than one occassion. But my original intent was for more than one nurse, a team of professionals to man the board, so that the load would not fall on one. Unfortunately, the moderator didn’t have any other trusted nurses she could put on the board, so the nurse ultimately did abandon her role as family and job issues were of the essence.
In a way, everyone is an expert as no two people have the exact same experience and we all have something to teach others. I consider you and Beth as experts in your respective areas. The net is a fantastic place to come to get information/education. The one thing the net lacks, however, is enough expert level advice provided at the teachable moment. By this I mean, when patients are having tx issues or need info about kidney disease, we need the answers quick and we need full, complete answers that aren’t lacking in substance or based only on opinion. Sure, every little bit helps and thats what we as the kidney community try to do- share our experience. But in addition to this good sharing, I believe we need support in the form of an ask the experts type board. Because the point is, it can take a very long time to grasp certain principles for our care without the benefit of clear, professional education. I often feel it is like putting pieces of a puzzle together, whereas if the professionals just did more educating we could get there much sooner and much better.
In conclusion, the reason I am bringing this up to you and Beth is because I think you are very qualified to manage an ask the expert type board. What better place than HDC? You have a great site here and I think it could be even better. We are told that dialysis should be a team effort. I’d like to see you branch out and really incorporate a team of professionals who could work with educated patients to broaden the site. It seems like each dialysis site has good and bad points. Personally, my idea of a site is one that is progressive to include as many forms of education as possible. Another thing I would suggest is that you take a survey of what patients really need and want in a site. I think you’ve accomplished a lot with this site and can go even higher. Thanks for your consideration.
just to add my experience…not to suggest a course of action:
I have buttonholed for over 8 years and never used a ‘buttonhole’ or dull needle…
I have no ‘damaged fistula’ (same one) and take care and good ‘aim’ has been working for me well. I use the same tweezers every day and initiate the scab removal with the fistuala needle first. I have never had a infected site. My ‘sterile’ technique involves almost never letting anyone else touch my fistuala or handle my equipment…‘my’ germs seem to be very ‘compatible’ with me.
Peace to the Peaceful
[QUOTE=A Traveler;13065]just to add my experience…not to suggest a course of action:
I have buttonholed for over 8 years and never used a ‘buttonhole’ or dull needle…
I have no ‘damaged fistula’ (same one) and take care and good ‘aim’ has been working for me well. I use the same tweezers every day and initiate the scab removal with the fistuala needle first. I have never had a infected site. My ‘sterile’ technique involves almost never letting anyone else touch my fistuala or handle my equipment…‘my’ germs seem to be very ‘compatible’ with me.
Peace to the Peaceful
A Traveler[/QUOTE]
Why do you use sharps rather then buttonhole needles?
[quote=A Traveler;13065]just to add my experience…not to suggest a course of action:
I have buttonholed for over 8 years and never used a ‘buttonhole’ or dull needle…
I have no ‘damaged fistula’ (same one) and take care and good ‘aim’ has been working for me well. I use the same tweezers every day and initiate the scab removal with the fistuala needle first. I have never had a infected site. My ‘sterile’ technique involves almost never letting anyone else touch my fistuala or handle my equipment…‘my’ germs seem to be very ‘compatible’ with me.
Peace to the Peaceful
A Traveler[/quote]
Thanks, A Traveler. I suspected there were folks doing this with no problems. When I’m ready to dialyze I just want to connect and not fish around with a dull for 5-10 minutes only to have to give up and use a sharp anyway. I wonder if there are others who have been using sharps on buttonholes with the same results. Erich
Well I am back! I had to redo my computer as my 200gb drive failed (I am right now on a 40gb due to lack of money)! On Wed they were able to use 2 blunts again but all the nurses are now afraid to cannulate me. Well that works out better for me becuase that means I get Becky all the time! She is the only one who it seems can cannulate me! But as I told her, when I get married if I live in PA I will need cannulators there to be able to cannulate me as I dont know if I will be able to cannulate myself considering where it is on my arm (I could only use one arm) and with having to hold the fistula and pull back because of the dip on the arterial … makes it a bit hard. What do you suggest?
The reason I don’t want to use sharps all the time is because I am not the cannulator. If it was just me then I would. I don’t even trust Becky with Sharps all the time because I don’t know if she does the correct angle all the time since she is harsh and just jabs it in instead of feeling around for the hole. That is the only way I can be cannulated however sadly enough it seems
I know of a women out here who has been using sharps in the same 2 spots for well over 10 years with no major drama. She does not use blunts simply because she is happy with using the sharps and does not see the need to change. She is a very determined women who likes to do things her own way.
Obviously it has worked for her. I have seen photos of her fistula and it looks fine.
Cheers
[QUOTE=beachy;13083]I know of a women out here who has been using sharps in the same 2 spots for well over 10 years with no major drama. She does not use blunts simply because she is happy with using the sharps and does not see the need to change. She is a very determined women who likes to do things her own way.
Obviously it has worked for her. I have seen photos of her fistula and it looks fine.
Cheers[/QUOTE]
Well with me my fistula kept getting infiltrated because of how curvey it is so I like blunts for that reason alone if any.
Well, sharp or dull…I’m sure we all have our reasons and justifications, but I wanted to share with all that sticking myself was THE BEST THING I’ve even done for myself outside of the spiritual realm.
Physically, psychilogically, emotionally…it changed my life for the better and I’ve only been glad of it since. I changed from being at the ‘mercy’ of anyone at any time to just get dialysis and survive to be ‘captain’ of my own ‘soul’…there is no way to overestimate in my opinion the results of before and after…
Once I began…and I did it by myself …in my room with no one around…I just determined I was going to do it…after many years of being stuck by others even my wife…once I did the relief was palpable and I never looked back…no one has ever cannulated me again and that was more than 7 years ago.
It is true that it is a hard thing to do to overcome the body’s natural tendancy against harming itself…don’t think that anyone is saying it’s easy, but once you conquor it the sense of accomplishment is euphoric and you will be OH SO GLAD that you finnally did it.
It is a freedom that is rare for those of us with ESRD…
So good luck to all …and to any that are thinking about it and sitting up on the fence, I will say I have not had Pain in a stick in years and from the 1st stick it NEVER hurt as much as when stuck by another.
[QUOTE=A Traveler;13087]
So good luck to all …and to any that are thinking about it and sitting up on the fence, I will say I have not had Pain in a stick in years and from the 1st stick it NEVER hurt as much as when stuck by another.
Peace to the Peaceful,
A Traveler[/QUOTE]
I think for me it is knowing my own impatience and knowing that until it is established I will just get so irritated at it not going in. Mine is so difficult and hard to stick. The nurse that cannulates me has to actually “Spear” me and that freaks out the other nurses lol. They are all intimidated by my fistula now … Becky says that once it is established (the buttonholes) that they should just “suck in” the needles. Then I will be able to do it no problem myself. But it has been 4 months almost … so … umm… when does it get to that point??
Should I start a new thread about this?
She is the only one who it seems can cannulate me! But as I told her, when I get married if I live in PA I will need cannulators there to be able to cannulate me as I dont know if I will be able to cannulate myself considering where it is on my arm (I could only use one arm) and with having to hold the fistula and pull back because of the dip on the arterial … makes it a bit hard. What do you suggest?