The beauty of buttonholes!

Just back from a post op visit to vascular surgeon who did some angioplasty just above site of my fistula surgery near wrist . The site that needed to be stretched with those little balloons was just below where I started buttonholing and was where I used sharps for 5 months of needling before I started buttonholing. It had developed some scar tissue and was restricting flow.

The good news is he was amazed how good the vein looked and showed me the X-rays.I was looking at a nice straight clear vein! Doing the buttonholes consistently in 2 spots over the last 15 months has made no difference to how the vein looked at those spots either! So therefore he thinks that buttonholing is a great way to go!

Well we all knew that but he didn’t!

That’s great!! Good for you!! :slight_smile:

Glad you got a good report.

Wow…that is amazing!..I have been only 7 months on home hemo doing buttonhole and I am happy doing so (¨happy¨is just a way of saying that is working for me, I would be really happy if I had a kidney!).

LOL Yep there is happy and then there is really happy!
Cheers

>buttonholing is a great way to go!
Ahhhh shuddup !! B-)

>The good news is he was amazed how good the vein looked and showed me the X-rays.I >was looking at a nice straight clear vein! Doing the buttonholes consistently in 2 spots >over the last 15 months has made no difference to how the vein looked at those spots
…but seriously, I’m glad it’s all O.K. for you.

I hardly ever come onto Home’Org now, as I’m not home, so don’t feel I belong…

I LOVE your signature!!

Also there is one nurse who never used to cannulate me but she did the one time and now I want her all the time! When SHE (Wendy) cannulates me she makes it seem sooo easy! They go in and she doesn’t have to harpoon me like the other nurses do! So now I know it CAN be done! BUT Wendy is getting transferred to the IV team … so I now know I MUST learn to simply do this myself as it looks like the other nurses just are not that good at it … not that my buttonholes are difficult like they have been saying :frowning:

Wish me luck! I was waiting on Wendy to see what angle and technique works best and then teach me but I might have to just teach myself!

Ahhhh Bear!
Been wondering how it has been going for you. Have you had the latest op? You WILL get back home mate, I am sure!

Buttonholing has been going great for me , yes, but my home training unit decided to order cheaper cannulas, didn’t they, which happen to be longer and fatter and don’t swivel @#@#******!
Cheers mate

[QUOTE=Bear;13194]>buttonholing is a great way to go!
Ahhhh shuddup !! B-)

>The good news is he was amazed how good the vein looked and showed me the X-rays.I >was looking at a nice straight clear vein! Doing the buttonholes consistently in 2 spots >over the last 15 months has made no difference to how the vein looked at those spots
…but seriously, I’m glad it’s all O.K. for you.

I hardly ever come onto Home’Org now, as I’m not home, so don’t feel I belong…[/QUOTE]

Hubby is doing wonderful with buttonholes too. Doesn’t it poison you when they change things that do’t need to be changed just because if money. You should have the choice of the nedles you are comfy with.

I pulled my own needles for the first time yesterday … .it is a start … plus I have been watching Bill Peckham’s videos on this: http://video.google.com/videoplay?docid=153372659747625126

I am waiting for the next time Wendy, the nurse who does the best and easiest job at cannulating me, is in so she can teach me. She says let’s get it going a few times in a row good … but with her not always being there that is basically impossible.

Also someone showed me this: http://www.nipro-europe.com/images/Video/FINAL_BioHole_NEW.mov

Does anyone do that BIO-Hole method??

[quote=AngiesKidney;13293]

Also someone showed me this: http://www.nipro-europe.com/images/Video/FINAL_BioHole_NEW.mov

Does anyone do that BIO-Hole method??[/quote]

That bio-needle method seems just a way to avoid using sharps 3-7 times or more to create tunnel…

Jessie started buttonhole 3 weeks ago while self training… he now self-cannulates…and he just loves it … he’s taking control of this situation and progressing at a steady diliberate pace… ultimately nocturnal/home without reservation… Jessie’s story here in Sudbury and his quest for home dialysis has picked up steam and may be going provincial.
Richard C/O Jessie

Awesome! You’re really making progress!

Also someone showed me this: http://www.nipro-europe.com/images/Video/FINAL_BioHole_NEW.mov

Very cool–good find. There was an article written about this technique in 2003:

Nephrol Dial Transplant. 2003 Oct;18(10):2118-21. A timesaving method to create a fixed puncture route for the buttonhole technique.

Toma S,
Shinzato T,
Fukui H,
Nakai S,
Miwa M,
Takai I,
Maeda K.
Toma Clinic, 972 Aza-Kochi, Nishihara-cho, Nakagami-gun, Okinawa Prefecture, Japan. stoma@air.linkclub.or.jp

BACKGROUND: Up to now, for a successful buttonhole puncture of the vascular access vessel, the fistula should be punctured by the same experienced medical staff for 2-3 months, using sharp needles, until a fixed puncture route is established. METHODS: We developed a timesaving method to create the fixed puncture route for the buttonhole technique. In this method, after the usual haemodialysis (HD), a newly developed thumbtack-shaped polycarbonate peg is thrust toward the access vessel along the same path as the puncture needle that has just been removed. Then, at the beginning of the next HD, the peg is removed and a dull puncture needle is inserted along the track already formed by the peg left in place. These steps are repeated at each HD session for 14 days. Thereafter, the vascular access is achieved at HD sessions by inserting a dull puncture needle through the established puncture route. RESULTS: This buttonhole puncture approach was used in 37 patients for 3 months. While the polycarbonate peg was in place, patients experienced no restrictions in their normal activities of daily living, except during bathing and showering. As for puncture pain, no patient found the pain of the buttonhole technique to be greater than that of the conventional puncture technique. Moreover, no significant bleeding was noted during HD. With this buttonhole puncture approach, only one patient had enough erythema at the puncture site to suggest possible infection. After HD, the time for bleeding to stop was <10 min in 95% of patients. CONCLUSION: This study showed the new timesaving method for creating a buttonhole to be safe and useful.


I’m not fond of the product name, which I think is unfortunate (maybe it was better in Japanese?), but the technique is interesting. I wasn’t clear on what makes the peg stay in the arm. Tape? It didn’t show any. Friction? Beats me. But Gus is right–this is a way to establish constant-site cannulation without having to use sharps, because you don’t have to re-open the tract each time.

[QUOTE=beachy;13203]Ahhhh Bear!
Been wondering how it has been going for you. Have you had the latest op? You WILL get back home mate, I am sure!
[/QUOTE]

            "Latest"??? I've had 2 (2.5 if you count a 'blow-thru' of the second clot) attempts at fore-arm fistuals clotted. I am a clotter. So got sent to haemotologist

on Weds. He can;t see any particualr reason, so should get the O.K. to go for upper-arm
one…sometime soon. Yes, I may get home…one day…still on the dammed permacath.
I can;t see me going back to buttonhole tho…might have to be day/evening runs from now on.

I thought this method might be something better, but after reading the article, I’m lost on what the advantage is. I thought buttonholes were supposed to take approx. 6-8 sticks with sharps to form and that’s it. That’s what mine took and it was simple. I wonder what percentage of patients needed longer than this to get their bhs established? Maybe this method has some advantages for newbies, but everyone who does bh must know how to proficiently get those sharps in should a bh close up. I know I went months before having one close up on me and I was pretty nervous that tx wondering if I would remember my sharps skills. Fortunately, it did come back to me like riding a bicycle, but I had my doubts and fears at first. I was really relieved to find that I still had the skill and had it well!

Learning to stick with sharps is not difficult- it is more fear than anything else, unless of course, one has a serious handicap. I would like to see patients who are going home feel more confident with their cannulation/machine skills due to more competent training. My trainer was very good as far as what he knew to do, but if a trainer is lacking in teaching ability or mastery of the tx, it causes patients to doubt themsleves. The better the trainer, the more completely/easily the patient learns. Thus, I think trainng programs should be better developed.

BH technique is so great! I just love it compared to all I went through in-center with all those, terrifying at times, sticks gone wrong. I am in control now- not a nurse or tech who doesn’t have much apptitude for cannulation or who is going through burn out etc… I used topical cream for yrs to get through the sticks and now I no longer need it as there is no pain with bhs. It is a great, great method!

I’ll second all that!!
Cheers

[QUOTE=Jane;13309]I thought this method might be something better, but after reading the article, I’m lost on what the advantage is. I thought buttonholes were supposed to take approx. 6-8 sticks with sharps to form and that’s it. That’s what mine took and it was simple. I wonder what percentage of patients needed longer than this to get their bhs established? Maybe this method has some advantages for newbies, but everyone who does bh must know how to proficiently get those sharps in should a bh close up. I know I went months before having one close up on me and I was pretty nervous that tx wondering if I would remember my sharps skills. Fortunately, it did come back to me like riding a bicycle, but I had my doubts and fears at first. I was really relieved to find that I still had the skill and had it well!

Learning to stick with sharps is not difficult- it is more fear than anything else, unless of course, one has a serious handicap. I would like to see patients who are going home feel more confident with their cannulation/machine skills due to more competent training. My trainer was very good as far as what he knew to do, but if a trainer is lacking in teaching ability or mastery of the tx, it causes patients to doubt themsleves. The better the trainer, the more completely/easily the patient learns. Thus, I think trainng programs should be better developed.

BH technique is so great! I just love it compared to all I went through in-center with all those, terrifying at times, sticks gone wrong. I am in control now- not a nurse or tech who doesn’t have much apptitude for cannulation or who is going through burn out etc… I used topical cream for yrs to get through the sticks and now I no longer need it as there is no pain with bhs. It is a great, great method![/QUOTE]

Well for someone like me I can see the advantage.

How so? Let me explain.

My buttonholes were started December 8th 2006. Today is Friday April 13th 2007. Over 4 months later right?

Okay, my buttonholes should be established by now right?

Well they are not.

Hardly ANY of the nurses in my dialysis unit can successfully cannulate me!

Only 3 of the entire staff can cannulate me 80% of the time.

So I figure the reason my buttonholes aren’t established is because the required first 6 times (14 days) having the same cannulator til they buttonholes are established … is virtually impossible unless you just do it yourself.

Right?

But my fistula is really snakey and someone needs to hold it in place while cannulation. I hold it while the cannulator cannulates me simply because I am very hard to cannulate and until we can tell just what angle is best and all, they want to hold off on teaching me, even though that IS the goal! Nurses who have been cannulating for 20+ years can’t even cannulate me! How am I ever to do it?

But I figure my buttonholes might have turned out better IF I had had the SAME cannulator for the first 6 times … which I did NOT.

Now with this Bio method it seems that even if you have a different cannulator that it is a way to fool-proof the establishment of the buttonholes.

Am I right?

Please correct me if I am wrong!

I am also aware that the Bio method could possibly be a slightly higher risk of infection.

I haven’t yet read past the post I quoted so forgive me if this is already addressed.

Thank you :slight_smile:

Okay … I scrolled down and saw Jane’s post before I hit submit so I just wanted to add this:

Jane, I am not the typical result. Usually buttonholes are relatively easy to establish. My arms have ALWAYS been difficult! Even simple IV needles all my life (well since I was 9 years old) required the hospital to always send for the best in your IV team while the rest just gave up. My veins have always rolled a LOT and I guess because of that my buttonholes are difficult as well :frowning:

[QUOTE=Jane;13309]
Learning to stick with sharps is not difficult- it is more fear than anything else, unless of course, one has a serious handicap. I would like to see patients who are going home feel more confident with their cannulation/machine skills due to more competent training. My trainer was very good as far as what he knew to do, but if a trainer is lacking in teaching ability or mastery of the tx, it causes patients to doubt themsleves. The better the trainer, the more completely/easily the patient learns. Thus, I think trainng programs should be better developed.

BH technique is so great! I just love it compared to all I went through in-center with all those, terrifying at times, sticks gone wrong. I am in control now- not a nurse or tech who doesn’t have much apptitude for cannulation or who is going through burn out etc… I used topical cream for yrs to get through the sticks and now I no longer need it as there is no pain with bhs. It is a great, great method![/QUOTE]

I think that is a HUGE part of it Jane! I don’t think my nurses are very skilled at Buttonholes! I think they just know to cannulate an AV Fistula with Sharps and that is all! When it comes to the Buttonholes I have heard a LOT of my nurses actually say “I thought cannulating in the same spot all the time was bad for the fistula!?” … that tells me that Buttonhole is not very well known in my unit.

Another nurse when I said that I had a lot of scar tissue said that there is supposed to be scar tissue with buttonhole. Well yes but not blocking the way

MOST of the time when they cannulate me with a blunt it just pushes the vien all over the place and then it gets even harder for them to find the right place. Plus mine isn’t just snakey side to side but dips down as well.

I hope no one else ever has the troubles I do but I just wanted to stress that my problems are not typical! So please don’t get intimidated by my story! Thanks!!

[QUOTE=Dori Schatell;13305]Up to now, for a successful buttonhole puncture of the vascular access vessel, the fistula should be punctured by the same experienced medical staff for 2-3 months, using sharp needles, until a fixed puncture route is established. METHODS: We developed a timesaving method to create the fixed puncture route for the buttonhole technique. In this method, after the usual haemodialysis (HD), a newly developed thumbtack-shaped polycarbonate peg is thrust toward the access vessel along the same path as the puncture needle that has just been removed. Then, at the beginning of the next HD, the peg is removed and a dull puncture needle is inserted along the track already formed by the peg left in place. These steps are repeated at each HD session for 14 days. Thereafter, the vascular access is achieved at HD sessions by inserting a dull puncture needle through the established puncture route. RESULTS: This buttonhole puncture approach was used in 37 patients for 3 months. While the polycarbonate peg was in place, patients experienced no restrictions in their normal activities of daily living, except during bathing and showering. As for puncture pain, no patient found the pain of the buttonhole technique to be greater than that of the conventional puncture technique. Moreover, no significant bleeding was noted during HD. With this buttonhole puncture approach, only one patient had enough erythema at the puncture site to suggest possible infection. After HD, the time for bleeding to stop was <10 min in 95% of patients. CONCLUSION: This study showed the new timesaving method for creating a buttonhole to be safe and useful.[/QUOTE]Wow thank you for that explaination Dori!

I notice they say

for a successful buttonhole puncture of the vascular access vessel, the fistula should be punctured by the same experienced medical staff for 2-3 months, using sharp needles, until a fixed puncture route is established
but I didn’t have the same cannulator more than 2 times… :frowning:

[quote=AngiesKidney;13311]Well for someone like me I can see the advantage.

How so? Let me explain.

My buttonholes were started December 8th 2006. Today is Friday April 13th 2007. Over 4 months later right?

Okay, my buttonholes should be established by now right?

Well they are not.

Hardly ANY of the nurses in my dialysis unit can successfully cannulate me!

Only 3 of the entire staff can cannulate me 80% of the time.

So I figure the reason my buttonholes aren’t established is because the required first 6 times (14 days) having the same cannulator til they buttonholes are established … is virtually impossible unless you just do it yourself.

Right?

But my fistula is really snakey and someone needs to hold it in place while cannulation. I hold it while the cannulator cannulates me simply because I am very hard to cannulate and until we can tell just what angle is best and all, they want to hold off on teaching me, even though that IS the goal! Nurses who have been cannulating for 20+ years can’t even cannulate me! How am I ever to do it?

But I figure my buttonholes might have turned out better IF I had had the SAME cannulator for the first 6 times … which I did NOT.

Now with this Bio method it seems that even if you have a different cannulator that it is a way to fool-proof the establishment of the buttonholes.

Am I right?

Please correct me if I am wrong!

I am also aware that the Bio method could possibly be a slightly higher risk of infection.

I haven’t yet read past the post I quoted so forgive me if this is already addressed.

Thank you :slight_smile:
[/quote]

There’s no guarantee, but try it! Only way to find out is to try it…

But none of my nurses have heard of it so I don’t know if I could get ahold of any to use :frowning: … In Canada anyway :frowning:

Have you tried to research whether you can buy some for yourself? Maybe just 20 of them…