It’s been a bit of trial and error working out the best method of scab removal for me as everyone I talk to that has done it (not that many) or a nurse that knows of it has different ideas. I was the first buttonholer my Vas surgeon had come across 2 years ago.
Anyway I use a 19g sharp needle to gently prise the scab off after careful washing and wetting with antiseptic. I have some stainless steel tweezers (boiled and disinfected) ready if it doesn’t want to lift. (lovely subject this). When I have been dialysing on holidays I have nurses say I should only use blunts to lift the scab, but that doesn’t work for me.
Recently someone told me that the preferred technique now is to leave some wet gauze over the area for at least half an hour to lift the scab…
As I am paranoid about getting an infection (after Bear’s trouble, transplant going well by the way) should I saying if it ain’t broke don’t fix it or doing the wet gauze stuff? What do you guys do over there?
Cheers
I used to be registered on this site. Guess I haven’t been here for so long that the site doesn’t remember me!! My user name was delphine or del!! Mel we were told at the start to use a 20g sharp to gently lift the scab and then take it off with tweezers. The new rules are DO NOT use a needle at all. Clean the site and just use the tweezers to get the scab off. This does not always work so don’t tell the nurse but we still use a nedle sometimes to lift the scab and then take it off with tweezers. Almost 2 years and no infections!!
Hey Mel , I use a 18g drawing needle to pick off the scabs , takes abit of digging sometimes but so far so good, i;m paranoid too about infection , been doing it like that for just over a year
My nurse instructed me to wash site with antiseptic soap, then use alcohol, betadine, remove scab with 18 ga needle. I’ve read where some have said they were told never to use a needle. I have had no problems, but I would still like to know the smartest way to do this. Anyone have any ideas on who the authority would be on this? I would like to call and get correct education.
I haven’t posted for a very long time. It has been a trying 10 months. However, I am hopeful I am not only on the road to recovery but also on the road to a transplant within the next 6 months or so (after 6+ years on the list), however…
I just had my monthly at my Wellbound Clinic. I was told in no uncertain terms NOT to use tweezers or needles as they create scar tissue around the buttonhole and enlarge them. They said I am to tape an alcohol wipe over both buttonholes after washing, leave it on during set up and prime and then use it, or gauze to rub off the scab.
Honestly, this works most times, but I have been know to give it a bit of a poke with sharp tweezers or a needle, if they are real stubborn.
Scab removal needs to be preformed in a way that the skin and tunnel track is not traumatized. The site should not bleed once the scab is removed. This is a list of safe ways to remove the scabs. You must also remember to disinfect the skin prior to scab removal and then again once the scab is removed. Use step 1 with all other options.
Loosen the scab edges prior to any of the scab removal methods. To get the scab edges to break free from the surrounding skin, take your thumb and pointer finger (after you have of course washed your hands) and place them on your skin surrounding the scab. Then pull the skin taut to break the edge of the scab free from the skin. Move your fingers around the scab and repeat the skin pull until you have stretched the skin all the way around the circumference of the scab. The scab should break free from the skin, but not bleed. Use light pressure to pull the skin so you just loosen the scab edges without causing trauma and bleeding to the scab site.
2nd steps can use any of the following methods:
Wash the skin in the shower prior to treatment and use a clean washcloth to scrub over the loosen scab and remove the scab.
Wash the skin at the sink just prior to the dialysis treatment. Use a clean gauze pad to scrub over the loosened scab and remove the scab.
Use a dull needle to lift the loosen scab off and out of the tunnel track. A sharp needle can cut the skin, damage the tunnel track, cause bleeding and lead to an infection.
Blunt tweezers can be used to lift the scab. The tweezers must be carefully cleaned before use and between the arterial and venous scab removal.
The Medisystems Buttonhole needles now have an option for a scab remover (dull plastic piece called Steri-Pik) that comes inserted in the end of the clear plastic needle cover. The Steri-Pick is removed from the needle cover right before use and is used to remove the single scab and then discarded.
The above methods are currently part of the CMS Fistula First cannulation training inservices. Hope this helps since our goal is to keep your buttonhole sites working well and free from infection!!!
Debbie was too modest to tell you that she is one of several national Buttonhole experts that I emailed asking if they would pop in and answer this question for you. (The others may weigh in yet, too, or may decide that Debbie’s answer covers it well enough that they don’t have to.) She speaks nationally about fistulas and the Buttonhole technique and helped develop Cannulation Camp and the Fistula First video that is used to train staff on how to put needles into fistulas.
[QUOTE=dbrouwer;16068]Scab removal needs to be preformed in a way that the skin and tunnel track is not traumatized. The site should not bleed once the scab is removed. This is a list of safe ways to remove the scabs. You must also remember to disinfect the skin prior to scab removal and then again once the scab is removed. Use step 1 with all other options.
Loosen the scab edges prior to any of the scab removal methods. To get the scab edges to break free from the surrounding skin, take your thumb and pointer finger (after you have of course washed your hands) and place them on your skin surrounding the scab. Then pull the skin taut to break the edge of the scab free from the skin. Move your fingers around the scab and repeat the skin pull until you have stretched the skin all the way around the circumference of the scab. The scab should break free from the skin, but not bleed. Use light pressure to pull the skin so you just loosen the scab edges without causing trauma and bleeding to the scab site.
My scabs are very small and tight. Step one does not work for me at all. I apply EMLA cream about an hour prior to tx. This softens the scab. I then wipe the cream off, wash with antisceptic soap, and then prepare site with alcohol wipes and betadine. With this method, usually the scab is gone, but if it is not, I have gently lifted it off with a sharp needle. I see you are saying not to use a sharp needle. I have been doing txs for 2 years like this and have never had a problem.
The only time I have an issue with my holes is after I take a day off (6 nights wk sunday to saturday am) So sunday night a scab may have formed and I just get a 2x2 or 4x4 put some alcohol on it and let it sit on holes for 1/2 hr maybe then apply lidocaine &prilocaine 2.5% for another 1/2 hr and I’m set. I use blunts and they go in like butter.
I’m a Nurse in Hemodialysis and NOT a scab picker! I believe we are doing more damage by picking of these scabs. There are increasing in size. I NEVER scrape of the scab with a needle. I get a warm WET cloth and place it on the sites while I do the rest of the assesment. Then using an alchol swab or betadine I rub the site…If the scab does not come off I PUT THE NEEDLE RIGHT THROUGH THE SCAB…NEVER have I had a problem. I hope this helps
Hi Nurse,
I’m so glad to hear that you have not run into any problems with this method. My understanding is that scabs are made of platelets and fibrin–but likely also contain embedded skin bacteria. So, going through a scab could potentially push staph or other bacteria directly into the bloodstream. Not something I would risk if it were me.
Being trained as a hemodialysis nurse, Im very suprised this is not a subject in which you were trained. Im sure you are pressed for time being a nurse in center, but sometimes that little extra time given to the patient can make all the difference. i find that many ( not all) in center facilities are just a rotating door with staff. Also, the patients are sometimes treated like a number instead of a person going in for a life saving treatment. Get them in, hook them up, take them off and repeat process…
I use lidocaine cream on the buttonhole. This softens the scab and I can easily peel it off using needle-nose tweezers. The regular tweezers don’t work for me because I can’t get a precise firm grip with them. I use an alcohol wipe on the buttonhole before and after scab removal. I also use an alcohol wipe on the tweezers before and after. No infections so far.a
There have beeen two main problems with buttohole cannulation. One is multiple cannulators using the wings to cannulate with. Thats a no. Go to http://fistulafirst.org/LinkClick.aspx?fileticket=u7wBDCUDeEQ%3D&tabid=127 to read about Touch Cannulation, which is best practice. Second is infection in Buttonhole tunnels. The problem 80% of the time is not removing the scab completely. The use of antibiotic soap and facial scrubbers (that’s right, scubbers) 10 to 12 times will remove all the loose scabs around the tunnel “trap door” opening. Use the same protocol you are using now to clean after using the scrubber, and then proceed to cannulate your access site. In my opinion, this will help reduce the infection rate and increase the life of your Buttonhole.