Button hole needling - blunt needles

[overthepond]

I know that this type of diaysis has been going on for sometime over in the US and at my unit they have just about found some funding to start on us guinea pigs, i mean patients and as I have been self needling for many years and am self sufficient when it comes to dialysis I have become the "chosen one".

i would be interested to hear what way you all start to use this type of needling - The way it is being done here is by using the EXACT same spot for the first 6 dialysis sessions, both A & V and then to use the "blunt needles" so as to create the tunnel.

I am quite excited about this as if it goes well it means I wont have to find new spots to needle.

Looking forward to hearing from you.

[monrein]

I've just started creating my buttonholes, using sharps.  I do two and a half hours Monday through Friday with Sat and Sun off.  Our plan is for me to use sharps for 2 weeks, so ten times and the try to switch to blunts.
From my research (on the internet and also here on IHD) my understanding is that this is the best way to avoid aneurysms and prolong the ultimate life of the fistula. 

We also plan to create another set of buttonholes, down the road when these two are well settled and functional.  We'll likely establish that set one at a time so we can rotate between these sites.

Be sure to search IHD also for more on buttonholes.  Epoman, the site's founder was a big proponent of them and there are posts of his on the topic.

I also know a woman who used to live in Denmark where she says they're the preference and Japan also has longer term experience with their use, from what I've gathered through the net.

[petey]

After 12 1/2 years of "sharps," my Marvin was excited when we started his buttonholes (when we started on home hemo training in July of 2007).  Here's how it worked for us:
In the first week of training, the same nurse came from "the floor" to cannulate Marvin with sharps.  She had me "fake" stick him to see how big my hand was and what angle was comfortable and "natural" for me (I'm his sticker -- he can't look).  She stuck him with sharps in the exact same spot (A & V) for five days.  The next Monday, I started with the blunts.  That was it.  I used the blunts for the rest of the home hemo training (about two more weeks in-clinic).  Been using blunts and the same buttonholes for 15 months now.

Every now and again, I have to revert to a sharp (after Marvin's one day off every week) because he's a quick healer and I need to open that track back up.  I probably stick with sharps once a month on average.  The rest of the time, it's blunts.  Marvin says it's still painful with the original "stick" because he has a nerve that crosses right over the top of his fistula.  We use Lidocaine cream, and after he's "on" and running for 10-15 minutes, the pain subsides.

We researched buttonholes thoroughly before we started home hemo training, and, like monrein, everything we read said buttonholes would extend the life of his fistula.  After 21 different accesses over the years (grafts, fistulas, and lots of perm caths), the fistula Marvin's using now has been working perfectly for 3 1/2 years.  Somebody knock on wood.

[monrein]

I just double knocked on wood for you guys Petey.

I've self cannulated now four days in a row and gotten all in OK.  Today's venous gave me a little trouble but in the end I got it.

[flip]

Baxter actually sells a bio needle kit which consists of needles and plugs to develope buttonholes. I've never seen them used. Maybe someone else has.

[monrein]

There is too high a rate of infection using the "plugs".  There's another thread about this on IHD.

[Wallyz]

Do em your self- most of the problems with the button holes is when different people work on them.  I have two sets,and alternate sites. I did one set in center, then read about using two sets, and set the seconds myself at home.

[monrein]

Do em your self- most of the problems witht he button holesis when different people work on them.  I have two sets,a nd alternate sittes. I did one set in center, then read about using two sets, and sett he seconds myself at home.

 

[del]

Hubby does nocturnal home hemo and has been using buttonholes for the past 2 years. He says needling is painless with the blunts.  Like Petey we have to use a sharp every now and again to open up the track.  I think Hubby is a fast healer too!!!  Hubby just has the 2 buttonholes at a time - one A and ond one V.  If something happens to a buttonhole tract we just needle with sharps to create a new one.  He likes the buttonhole tracts a lot better than sharps!!!  According to the rsearch we have done buttonholes are a lot better for the fistula. He used sharps for 6 years.  He has never had any fitula problems - had a fistula developed in 2000 and it is still working great!!!