Starting Home Hemo

Hello all - I will be starting home hemo on Jan. 4th. I would like honest opinions as to how difficult it was for any one of you in starting your buttonholes. My fistula is fresh and needle free right now. Just curious as to how tolerate to pain I have to be?? Be honest people. I got a prescription for the Elma cream, but have heard some people say it didn’t work for them.

I think I tolerate pain pretty good, but am scared to death about the training facility sticking me.

How did all of you tolerate it?

Hi Catwoman,

Welcome to Home Dialysis Central! It’s understandable to be afraid of other people cannulating your fistula. You are the only person on earth who can feel both ends of the needle–so you should be able to do a better job than anyone else can.

I’m not on dialysis, but just wanted to pass along that sometimes when folks say EMLA “doesn’t work” for them, it’s because they’re not using it right. It has to actually soak into the skin. A dime-sized blob–fairly thick, like 1/8"–should be placed over each needle site, and then covered with plastic wrap or a tegaderm dressing (these can get pricey). If you leave the EMLA on for 2 hours, it will work. Often people either don’t put on a thick enough layer, or don’t leave it on long enough.

Incidentally, there are other products that contain the same active ingredient as EMLA (lidocaine) but are less costly, like Less-n-Pain, LMX, and Topicaine.

The question is - how do I know where to put the ELMA creme on the first time since it hasn’t been stuck ye?. Do I simply put a long line on my bicep area?

Hi catwoman,
How does your team plan to approach establishing your buttonholes? Will they have you cannulate the sharp needles to form each buttonhole or will the nurse do it? The process was easy for me, because when I was still in-center, I was taught how to self-cannulate using sharps with the ladder technique for a few months before I started the SDD program and formed my own buttonhole sites. I think it’s important to have this skill first, because should a buttonhole site ever close off one day ( this happens from time to time), then the patient will know how to use a sharp to re-open the buttonhole site.

As far as EMLA cream, I consider it my best friend as it has made the needle insertions pain-free or nearly so. Some patients say they don’t need it at all, but others like me have benefited greatly from this aid. It does not necessarily take 2 hrs. Everyone is different on that. Some days I put it on and wait less then an hour and it works fine. Other days I keep it on longer since I am busy with something and it may be 2 hrs before I get on. Just work with it and see how long you need and be sure to check that it hasn’t rolled off your site under the plastic. I use tegaderms to cover- it is the simplest way to go and you don’t have to keep checking your arm to make sure the covering hasn’t fallen off.

One day prior to your first session your nurse should decide on 2 sites for your buttonholes. That is how you will know where to put the cream. Be sure that your fistula is established enough before starting the buttonholes. Once you get going you will be so glad you are using this technique. You will have some days where you can’t seem to find the openings. But as you work with it, you will learn how to get your angles right and get in faster.

Thank you for your post. Per my team, they stated they would start the buttonholes. I don’t quite understand how they do it, but I guess I will learn in the long run. Thanks for the info. on the Elma cream. Whew, that made me feel better that it does in fact work. Believe me, my arm is truly mature enough - when you’re bench pressing 60 pounds and doing weights five days a week for 2 sets, yup, my arm is truly a work of art…just a little bragging there.

Not that I’m a wuss or anything, but I don’t know how they are gonna start the buttonholes, if I’m the one going to stick myself. Well I guess I’ll find out the first day, won’t I !! :slight_smile:

Thanks again guys. Really appreciate your time and support.

Hi Catwormen,

Dont be too worried. Emla Cream works great. I put it on approx 45-1.5 hours before my treatment. I find that if I put it on any longer than 1.5 hours, it tends to burn the skin. Everyone is different. i have used it as few as 30 minutes before and it still works.
Before you start your buttonholes, just ask whoever is going to create them, the location and all you have to do is just put the Emla Cream on in the Area. Make sure the same person is dedicated to sticking your fistula when creating the buttonholes. Do not let multiple people careate the buttonhols.
Afer a while, you get used to the sticks believe it or not and with Emla Cream its a breeze. Dont worry, you will be fine.
Where is your fistula located?


Also, when starting your BH’s make sure you tell the nurse what angle is best for you. SOmetimes a nurse will stick you with an angle best for them, sometimes standing up. You will be the one self-cannulating so it has to be good for you.

Hi Catwoman,

I would suggest starting with the EMLA. I have been on dialysis for 5 years, and while I no longer use EMLA (pain becomes substantially less/to non existant) with buttonholes over time, it was a Godsend at first. Personally, I feel that ‘being brave’ or ‘toughing it out’, is silly. If it doesn’t have to hurt… all the better.

I applied it along the fistula (have the nurses point it out to you before hand), and then wrap your arm with saran wrap. (I did so about 60 minutes/in my case travel time) before my planned treatment - and it worked just fine. A CAUTION… be sure to wash your hands VERY well afterwards. There is nothing more difficult then trying to needle one arm, with a numb hand! ha ha… Lesson learned. You will after the first few treatments, know where the sites are, so you can modify your application accordingly.

All the best, and feel free to come here often with questions. While we are not ‘professionals’… we have tried/tested/true, experiences.