Button Hole.. Is it all they say its cracked up to be??

[monsterman]

Hello again everyone,
Its been awhile since I've come to the boards, life, Dialysis and all kinds of other things have kept me away.. Well anyway I've been doing ok. If you dont remember I have a Fistula, my unit has been pushing everyone to go to the Button Hole. So I did and it was or seemed to be working quite well. Then I started to develop 2 small lumps where my Button Holes were. I did not want them to get any bigger and started 2 new holes a few weeks ago..

Well earlier this week I had a lot of problems with my flow rates, etc. Well turns out my Fistula narrowed again this is like the 4th time and this will be the 4th or more procedure next week to fix the problem, the one surgeon is talking stints the other says no.. Now my question is should I stick with the Button Hole or go back to sharps? My Vein is at the very top of my skin no digging or hunting for it and it seems with the sharps I was getting infiltrated at least 1-2 times a week and this is the entire reason why I went with the Button Hole. I've even learned how to stick myself "with the blunts"!!

The surgeon I saw on Thursday told me that the Button Hole causes to many bad things, blockages, aneurysms, etc.. Now my Unit tells me something totally different? So what the heck is the real truth behind the Button Hole someone please give me some advice before I decide to just stop going!! LOL

[BigSky]

Buttonholes do not cause blockages or aneurysms, neither do sharps or intermediates.

Those things tend to occur as a result of the structure of the vein, more a genetics thing than anything else.

Some peoples fistulas develop nicely and swell quit a bit, others will develop very nice in some areas but be narrow in others and some people have fistulas that develop poorly and barely swell up at all.


I have seen people develop aneurysms and blockages right off while others have gone years being stuck in the same spot with sharps  and buttonholes and not developed them.

[Pam]

I have never been infiltrated or had a blockage or aneurysm.I have been using the same buttonholes for 19 mos. I wish I could get a decent picture to show up. My buttonholes look like 2 very small mosquito bites. No bumps or lumps at all.

[Desert Dancer]

Monsterman, your surgeon is talking out his  Tell him to stick to surgery.  If buttonholes were so bad I'm sure they would not have been using the technique for more than a quarter-century already in Europe.

How old is your fistula? They continue to grow, move and develop for quite some time, and my understanding is the average fistula will require several interventions before it's really up and running. If your fistula is still young, I would tend to think that's what is causing it to narrow, not the buttonhole creation.  Buttonholes are encouraged specifically because they don't cause problems such as aneurysms.

Best of luck to you, whichever way you decide to go.

[BigSky]

Something on buttonholes.



Strategies to Improve Complications Rates with the Buttonhole Technique

https://ifmcevents.webex.com/ifmcevents/onstage/playback.php?FileName=http://www.nwrenalnetwork.org/QI/wrfs/F-ESRDSTRATEGIES111709.wrf

[dyann]

I use the buttonhole and I have had 4 fistulagrams,  but not because of it. the buttonhole area should be a little
bigger kind of like a little hill not huge but bigger,  it takes some getting used to I have only had my fistula working since may and there have been many issues with it but not because of the buttonhole. One of the surgeons told me the samething that using the same area all the time would cause issues, but even when I switched I had ssues, it is just the genitcs some people do well for yrs others have issues.  This probably didnt help but that is really the way it is.
good luck

[josie]

I love my buttonholes!!!! Easy to access, and I was having the same problem as you when the unit was using sharps and infiltrating me several times! I do home hemo, and my husband feels much less nervous access the same buttonhole every day.It's like an earing, once you get the buttonholes established, that track is dead on for cannulating. And the bleeding time when you remove the buttonhole needles is probably one third the time as sharps.

[Bruno]

WE had a surgeon like that at our centre...really against buttonholes...he's a really brilliant man. Anyway after years of being against it, he changed his mind and is now a buttonhole enthusiast. So am I...but remember, BH's are not for everyone, there are some conditions they can't handle. 

[tyefly]

I am thinking blood flow rates.....   I turned down my blood flow rate to 350  from  430 ( which is where my center wanted me to be....)   I hate too many problems with Arteral pressures.... just a little high as time went on the machine..... My understanding is its the blood flow speed that created problems with the fistula.....  slower speeds are much better  and then you wont have to have all those fistulagrams .... like so many do while running 400 or better...  the centers want you to run as fast as you can so that can turn you and get someone else in the chair.....  They are no thinking about want is best for you or your fistula.....   I find it very hard to do incenter.....  just for that reason......   try to turn your blood speed down..... 

[Bruno]

Gee Tyefly, 300 is my top speed with button holes and we slow it down even more if we have pressure problems.

[billmoria]

I love my button holes. I try for 400 speed but I watch my venus pressure very carefully. We start at 350 and I raise or lower it according to my venus pressure. Our hospital wants us to monitor and do this for ourselves. If my pressure reaches 225 I lower the flow. If it is below 200 I raise the pressure.
You can never tell - one day 340 another 400 but mostly somewhere in between.

[boswife]

NICE info BigSky!!!  thanks VERY much for sharing that!  I'll be canulating for my hubby soon and this is great!!

[monsterman]

Well its been awhile since I was on here or updated this thread.. Ive been using my Fistula/buttonholes now for going on 9+ months with no real problems. I've been on Dialysis going on 4 years now. Have had many visits to the vascular surgeon. I go about every 3 months and every 3 months I end up having a narrowing, some scar tissue etc.. Its a walk in the park now, an hour or so on the table dr does his thing and I am done and heading home before i know it.

Dialysis has not been that bad, I've left feeling pretty good some days and horrible others. I guess its one day at a time or should I say one treatment at a time eh..

[boswife]

good to hear from you and glad all is well    I am doing hubbys needles for almost a whole year now and so far so good.  Buttonholes BTW...   Hope they last a whole lot longer too