Buttonholes

[calypso]

So I'm going for home hemo on NxStage soon.

New fistula to be cannulated using buttonholes in January.

They are telling me they want to cannulate 3 times a week to develop the buttonholes. I think I read somewhere it needs to be cannulated close to every day to develop the buttonholes properly right? Otherwise they might begin to heal before the track is established? Am I right or is 3 days a week enough to create new buttonholes?

[rsudock]

I am on in center D 3 times a week and I have button holes. They were established just fine. Just matters how well you heal. I for some reason can't use the blunt needles though and continue to have to use sharps on my button holes.


xo,
R

[YLGuy]

My buttonholes were established in center going 3 days a week.  I use the blunt buttonhole needles and self cannulate in center.

[Desert Dancer]

I think it just depends on how quickly you heal. While I was establishing my buttonholes I was going in-center five days a week doing short daily and they seemed to be well-established. Once I got home, however, and switched to every other day the buttonholes slowly started closing until about a month in they were almost completely closed. So now I either have to sharp stick occasionally to re-open them, or I have to cannulate every day. I'm hoping at some point my body will just give up and let them stay open.

[sbrown2459]

I have hemo 3 times a week and my button holes were developed at the center. One of the button holes is "new"; the first attempt was not successful and a new access was developed. One thing I would recommend is the use of Emla; Emla, or generic, is a creme which helps to numb the skin at the access site. I apply the creme about 1 1/1 hours prior to my treatment. I feel a little bit of pain on the lower access, but no pain at all on the upper access site. The lower access site is "older" and I think there is more clotting under the skin. From personal experience your center should be able to develop the button holes within a month.

[M3Riddler]

So I'm going for home hemo on NxStage soon.

New fistula to be cannulated using buttonholes in January.

They are telling me they want to cannulate 3 times a week to develop the buttonholes. I think I read somewhere it needs to be cannulated close to every day to develop the buttonholes properly right? Otherwise they might begin to heal before the track is established? Am I right or is 3 days a week enough to create new buttonholes?

Calypso,

You have read correctly, the recommended  method is to develop them with 8 or so consecutive sticks without a break in between.  Sometimes it takes more, sometimes less.....They should also be created by the same person each time as everyone holds the needles at a different angle, stand in different positions etc... This is most important when creating the buttonholes....If you give it a chance to heal, then are you creating more scar tissue that you are breaking through after a day or weekend off.

If you are not doing daily dialysis, then the center may not go anywhere out of their way to have you come in every day just to get stuck to establish your buttonholes. If you are currently in-center, then this is how they are going to create them.  Hopefully by the same person. This is another drawback of in-center. They are not going to have that extra seat for you to come in every day.
If you do not live far away, perhaps ask if you can come in on your non-scheduled day just to stick the buttonholes ( not receive dialysis) to establish them. 
Im sure you will have no problem doing it 3x per week, but it may take longer. Remember, you are on their schedule, they are not on yours...That is the beauty of home dialysis. You create your own schedule.
Perhaps ask if you can com in on your day off just to be stuck ( hopefully by same person) Your center may not go for this....

Good Luck!!!

[calypso]

Thanks everyone, your posts have been very helpful. Happy Holidays!

[calypso]

Now I called another clinic that does nocturnal home hemo (they don't do it at my regular clinic. But the nurse there told me they prefer it if the fistula is used prior to starting creating buttonholes!  What the?!

I asked her if the ladder technique doesn't create scar tissue and make it more difficult or offer less sites for establishing buttonholes and she said no. They want me to start using the fistula in center slowly at first with one needle and use the catheter for the other side and slowly build up pressure till the fistula gets bigger before establishing the buttonholes. This is different than what my regular unit told me that they want to be the first ones to start the fistula.

I don't know who to believe. Help again? Thanks! 

[Desert Dancer]

My clinic, too, suggested to me that we do a couple of sticks first... just because, I guess.  I told them no thank you, if we were going to stick the fistula anyway than we might as well start the buttonholes and not fart around with a bunch of extraneous sticks that weren't contributing to anything and would only serve to weaken the vessel wall.  They shrugged and agreed, and I've never had any sticks but buttonhole sticks.

Really, I think this is your decision, not theirs - it's your fistula. How old is it? Mine was 7 weeks old when I started using it (created 8.25 and first use 10.21).

Also - as far as 'building up pressure' - if you're looking into nocturnal then your pump speeds will probably be very low (mine is 250) and won't be a source of stress to the fistula anyway.

[calypso]

Thanks Desert Dancer. Mine was created September 29th,2010 but it clotted 1.5 months later and they did an angioplasty in Nov.

[tyefly]

 When I first started D   I had a new fistula.....  had to do laddering  for several weeks untill my fistual got a little broke in ....toughen up....   then we started button holes.....  the same person at the center did mine  even if she was in a other section she came over and did mine.......  did it for about three weeks...total of nine time... and they were established...even though she could never get the button hole needle to go in easy and had to use sharps.... when I started Nxstage....the second day  I used buttonhole needles and they both went in pretty good.....   I have a upper arm fistual which makes things difficult...as my venous is deep....( now using a 1.5 inch needle...)   even today...it takes time to get those needles in...expecially if I am not at the correct angle....never a problem with my arteral  as it pretty close to the surface....   So I think it just takes time..... I spend more time cannualting myself  than what they would put up with in center....so  dont worry   you will learn and it will work...... 

[Desert Dancer]

Thanks Desert Dancer. Mine was created September 29th,2010 but it clotted 1.5 months later and they did an angioplasty in Nov.

Calypso, do they know why it clotted? I'm sorry you had to go through an angioplasty.

[calypso]

Calypso, do they know why it clotted? I'm sorry you had to go through an angioplasty.

I posted about it here: http://ihatedialysis.com/forum/index.php?topic=21008.0

[FineWhine]

Whoa, guess I've been pretty lucky, my buttonholes worked right away. The tech who started them is having every other tech cannulate me so they get to know the "paths", but she is the best, pops 'em right in.  My fistula is small and curved on my upper left arm. I am left handed, so placing them myself is freaking me out. But seeing what you went through has given me courage.  I can do this!

[Desert Dancer]

Geez, calypso, that really sucks.

[1sickbob]

Our center, RAI would not do buttonholes.  They left it up to us to do this because of the different angles different people use to access the vein.  This has worked out great for us and has given us TOTAL control of my fistula and who gets to beat it up.  I think there have been infection issues with too many people using a buttonhole too.

[lmunchkin]

Sickbob, that is the very reason I do not use buttonholes on my husband, infections!!!!!!  He has had so many infections over the years that I find it best 2 stick him in different places every time. I bet though if not for the infections, I would probably like the buttonholes best!

lmunchkin

[tyefly]

Sickbob, that is the very reason I do not use buttonholes on my husband, infections!!!!!!  He has had so many infections over the years that I find it best 2 stick him in different places every time. I bet though if not for the infections, I would probably like the buttonholes best!

lmunchkin

I have been using buttonholes for over a year.....  and I cannulate myself..... I have never had a infection....... Never......  I would Never us anything but buttonholes...... No pain.....

 I think if you are getting infections   I would think that you need to do things differently.....  Infection control is important no matter what type fo access you have....

[monrein]

Never had infections from my buttonholes either.

[lmunchkin]

If it aint broke, dont fix it. Stick with what works for you.

lmunchkin

[del]

Hubby has been doing buttonholes for 4.5 years now and no problems.  Occasionally we have to use a sharp to open one up.  No infections at all.

[graceb]

Hi, just wondering if my brother has started with laddering, will it be harder to get buttonholes established later on? He asked that they start today with buttonholes. (His fistula has been used for a month now.) They said the fistula still needs more maturation (the fistula was established about 7 weeks before they started using it...so it is about 11 weeks old). Any advice/thoughts as to whether he needs to be pushier about getting the buttonholes started sooner or just wait as they recommend? He goes to a big dialysis center in Los Angeles.

[monrein]

The main thing is that he ladder consistently and methodically, not just alternating easy spots...don't want to develop too much tough scar tissue, but I would keep asking about starting the buttonholes and get a firm timeline.  Don't let them go the route that's easiest or most likely quickest for them.  Best of all, try doing them himself by starting with the sharps.  Self-cannulation is absolutely better for a fistula in the long run, unless you have the same person doing them each and every time.

[billmoria]

I am in center M_W_F. My button holes were developed over two weeks - 6 sections. They work excellent - I love them and I now bleed a lot less than when I was using sharps.