Need Advice Re: Adjusting Veinous Needle In Buttonhole During Treatment

[PrimeTimer]

You know how it goes, not every day is a good day and not every needlestick is perfect. So what to do when you know your "veinous stick" is a bit off and now you have a high veinous pressure? Do you just lower the Blood Flow Rate and ride it out or stop the blood pump, remove the needle, apply pressure and then start over with a fresh needle or...just make an adjustment and hope for the best?? My husband and I made a slight adjustment to the needle without fully removing it and just finished out treatment at only a 220 Blood Flow Rate. We did not want to remove the veinous, apply pressure and start with a new needle because that would have meant that the arterial needle would have had to sit and wait it out all that time too (possibly coagulating) and we didn't think that was a good idea. Any suggestions? 

[obsidianom]

You could have left the venous needle in and just clamped it off and taped it down and not used it. Then you could quickly do another venous needle sharp further up . That would have worked fine. Having 3 needles in is not a problem as long as you secure them and clamp off the un-used needle . We have done that before.

[noahvale]

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[Speedy1wrc]

Did you try flipping the needle over?

My access is pretty big so I usually don't have problems. But in the past I have flipped needles, stuck a piece of folded gauze under the wings to give a different angle, and sometimes a good flush with saline will also clear it.

Worst case I have flushed the opposing needle and pulled the bad one. I have been able to get another in while periodically flushing the remaining needle to keep it from clotting off.

[Dannyboy]

In addition to all the comments/advice above (I think I've done almost every one mentioned), for me personally, (I use 14 GA x 1" long), withdrawing the needle slightly has sometimes made a huge difference, or putting a folded 2 x2 under the tubing right near the cannulation site to slightly change the angle also works sometimes. 

I also modified the settings on my NxStage machine to more slowly "rotate" displaying thru the various numbers.   When you're having problems with either needle, it is maddening to have the value display so briefly that you can't immediately see the effect of a change until it comes back around, and then only for way too short a time.

[noahvale]

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[PrimeTimer]

We use 15 gauge blunts on buttonholes and are terrified of using sharps and infiltrating or damaging the buttonholes and/or fistula. So what we do, is remove the veinous needle if we get a bad stick, hold pressure with gauze and wait several minutes, swab again with alcohol and go back in the same buttonhole using a fresh needle. It's been working okay if we have to do that but I just wondered if there was a better idea...of course, avoiding sharps. My husband recently had an angioplasty on his fistula and it has seemed to move or change the angles and depth we need to go in at on his buttonholes.

Lesson learned: Any time you have a revision done to your fistula, there's a possibility that it might change the angle and/or depth you will use for cannulation. Once you find the right angle/depth, write it down so you'll have something to reference to until you have it memorized, that is, until the next revision..

 

[noahvale]

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[obsidianom]

We use 3/5 inch needles and would never go back to using longer needles.
Sharp needles in a fresh hole dont cause problems. Thats what we do 5 times per week. We have never had a fistula issue of any sort since doing ths. I am not a big fan of buttonholes. there is no evidence they save the fistula and have higher infection rates and more issues like you are describing with access angles etc.
I think sharps get a bad rap due to the way it is done in center by lazy staff.  Since we switched back to sharps from buttonholes we are much happier and less stressed.

[Speedy1wrc]

The only way any access can get infected is by poor aseptic techniques. My assumption is that people with buttonholes who do get repeated infections take shortcuts. It's easy to lose ones discipline and become complacent.

[amanda100wilson]

Noahvale, you have to work with what you've got.  My arterial pressures are much lower with a half-flipped needle.  It may not be best practice, but you have to do what you have to do, treatment.  You can't worry about what will happen one to two years down the line, because you have to worry about the treatment today.

[nursey66]

My Hubby started out with the "button holes" because the clinic wanted him to use it. But after so much trouble and time it took, he refused to do the button holes and says the needle sticks are much easier, faster, and he doesn't mind the stick at all.

[obsidianom]

The only way any access can get infected is by poor aseptic techniques. My assumption is that people with buttonholes who do get repeated infections take shortcuts. It's easy to lose ones discipline and become complacent.

I am a trained SURGEON with impeccable aseptic OR technique. I had virtually no post op infections in my career. Mt stats were excellant at the hospital and office. Yet we had an infection in the buttonhole at home within a month or 2 . I was very careful handling the fistula and used Stuart Motts training. It still went bad and ledto a serious infection and need to catheterize for a week. I wont go back there. I am much happier with sharps as is my wife. She doesnt have to worry as much either.

[Speedy1wrc]

As long as it works for you, that's all that matters.