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!!!