Self-Cannulation: Questions and challenges when starting.

I am not a home hemo person, I am doing in-center (for the past 9.5 years for that matter). Recently I decided I don't want to deal with people who are bad sticks anymore in my life (my clinic is great, but there's always the possibility that someone bad might show up, or that I might move to a new area) and I figured no one can know my arm better than me, so I've begun training for self-cannulation and removing the needles on my own.

Here's my cannulation set-up: Left forearm arterio-venous fistula (10.5 years old!) using 15 gauge sharps (not buttonhole). I am right-handed. I haven't yet fully stuck in the needles; my preceptor puts it in partially, then I drive it home and flip it (I have to flip, otherwise I can't reach my optimal BFR ... this is another reason why I want to self-cannulate. I've been to clinics where they make it a big deal to have to flip, and don't flip unless arterial pressures are high. I know that my pressures will be high unless I flip, so I get that out of the way all the time before taping up). I was pretty much surprised at how much resistance there is from the skin (granted I have tons of scar tissue, but that's another story).

Anyway, I am not TOO worried about putting the needles in, or taking out a needle facing "up" (pointing to the elbow), because I can just use my left hand and pull on the tubing to pull the needle out safely into the guard. The clinic's policy is that needles pulled MUST be pulled into the guard if the patient is removing them by themselves. With the shape of my fistula, in some areas I have to insert the arterial needle "down" (pointing to the wrist). Inserting isn't a problem. Figuring out how to safely pull the needle and apply pressure from the "down" position is. I'm the only patient the clinic has known that has a down-pointing arterial cannulation that is attempting removing the needle by themselves. I came up with a system (ring & pinky partially putting pressure with gauze, middle finger holding the butterfly back, index and thumb slowly pulling the needle into the needle guard), and I tried it recently, but my timing was off and wasn't able to put pressure on in time. Fortunately, I had the tech hoover over me while I was attempting it and she stopped the bleeding.

I have considered buttonholes so that both my needles can be in the "up" positions on every stick (currently I use the ladder method to rotate my sites), but I do not want to pursue that option at this time

So basically, I am asking if anyone here has experience pulling a down-facing cannulation with only one hand, how to safely pull the needle and apply pressure at the same time with one hand when the needle is facing "down"?