Another study on Buttonhole Cannulation at Home

[obsidianom]

This is another study done on Buttonhole cannulation at HOME. Take it for what its worth.
Personally I do rope ladder on my wife. Its simply easier and less stressful. I dont worry as much .


http://www.ncbi.nlm.nih.gov/pubmed/24370768#

[Jean]

Obs, I have been convinced all along that when I go on D it will be the best I can do, so I opted for in centre hemo. However the other day some one posted a picture of a dialysis needle next to a regular needle and I nearly fainted!!! Also I had just gotten to the point that I was convinced I could stick myself so took up an interest in buttonholes and laddering and now I am just all muddled up. My GFR is 20, so I have a little time left to decide. My neph is very smart, but not much of a bedside manner. He feels it is too early to even discuss D, so were it not for IHD, and people like you, I would be completely lost.

[amanda100wilson]

Jean, you can do it.  They are scary when you first see them, but I use buttonholes and hate the idea of other people poking dialysis needles into my fistula.  In this journey that we share where so much control is taken out of your life.  I strongly encourage you to be your own advocate, and take control over your life and health as much as you can.  It is truly empowering.

[Cowdog]

I don't understand the statement about increased initial and ongoing staff time requirements. On home Hemo?
In center with random staff doing the cannulation buttonholes may not be a good idea but for self cannulation I think they are the best option. Especially if you establish the buttonholes yourself.
Infiltration data should be included in the incenter rope ladder studies.
My dialysis life got sooo much less stressful when I stopped depending on luck of the draw cannulators.

[Maggie and Jeff]

I don't understand the statement about increased initial and ongoing staff time requirements. On home Hemo?
In center with random staff doing the cannulation buttonholes may not be a good idea but for self cannulation I think they are the best option. Especially if you establish the buttonholes yourself.
Infiltration data should be included in the incenter rope ladder studies.
My dialysis life got sooo much less stressful when I stopped depending on luck of the draw cannulators.

+1

8+ years buttonholes 2 infiltrations both were with sharps First one was done by nurse during training I did the second one.  No infections yet. Only one fistula. I'm the sticker she is the stickee. 

[obsidianom]

Obs, I have been convinced all along that when I go on D it will be the best I can do, so I opted for in centre hemo. However the other day some one posted a picture of a dialysis needle next to a regular needle and I nearly fainted!!! Also I had just gotten to the point that I was convinced I could stick myself so took up an interest in buttonholes and laddering and now I am just all muddled up. My GFR is 20, so I have a little time left to decide. My neph is very smart, but not much of a bedside manner. He feels it is too early to even discuss D, so were it not for IHD, and people like you, I would be completely lost.

Why did you write you opted for in center hemo?  Unless it is over night extended, it is the worst type you can get at 3 times per week for fairly short sessions. Think about doing either nocturnal in center or at home where you get a lot more dialysis and have control of it. What about PD?
If you are going to need hemo, NOW is the time to get a fistula surgery and allow it time to mature. This way you wont need a dangerous catheter.
Dont worry about the needles. Beleive it or not they arent as bad as they look. I stick my wife with fresh sticks 5 times per week and she barely feels them now .
ASk any questions you have and I can try to help.

[obsidianom]

I don't understand the statement about increased initial and ongoing staff time requirements. On home Hemo?
In center with random staff doing the cannulation buttonholes may not be a good idea but for self cannulation I think they are the best option. Especially if you establish the buttonholes yourself.
Infiltration data should be included in the incenter rope ladder studies.
My dialysis life got sooo much less stressful when I stopped depending on luck of the draw cannulators.

What they meant by increased staff time was dealing with infections and complications of fistula problems. Even in home hemo any complications will take staff time to deal with.
We use short needles for the fresh sticks and that makes it easier than the long needles. Generally I THINK THE REGULAR NEEDLES ARE TOO LONG ANYWAY.
We use 3/5 inch needles .

[obsidianom]

I don't understand the statement about increased initial and ongoing staff time requirements. On home Hemo?
In center with random staff doing the cannulation buttonholes may not be a good idea but for self cannulation I think they are the best option. Especially if you establish the buttonholes yourself.
Infiltration data should be included in the incenter rope ladder studies.
My dialysis life got sooo much less stressful when I stopped depending on luck of the draw cannulators.

+1

8+ years buttonholes 2 infiltrations both were with sharps First one was done by nurse during training I did the second one.  No infections yet. Only one fistula. I'm the sticker she is the stickee. 

Stay with what works for YOU.  Glad to hear you are doing so well.

[Maggie and Jeff]

Generally I THINK THE REGULAR NEEDLES ARE TOO LONG ANYWAY.
We use 3/5 inch needles .

My wifes fistula is in her upper arm and her vein is deep.  We use 1 inch needles and only about 2 - 3mm going to the fistula but we use the whole inch most of the time.  There are a couple spots closer to the surface and when I'm using one of those I don't put the needle in all the way.   

[obsidianom]

The shorter needles are more important in the sharps anyway as that is where the biggest risk of infiltration is. Obviously if you have a deep fistula you require the longer needles.

[Sugarlump]

My top fistula (venous access) runs much better if the needle, after insertion, is drawn back a little (so not fully in). They appear to have only one length of needle in my center!

[Jean]

Sorry I meant to say I was going for nocturnal in center HD. All of this with an eye to learning to cannulate myself. I simply can not imagine it.

[obsidianom]

You can do it. I used to be afraid of needles when I was young. What got me over it was doing it to myself . Now it never bothers me. When you do it to yourself you have the control .

[cassandra]

Hi Obsi, do I understand that this study is a comparison between rope-ladder at home versus buttonhole in clinic? Or rope-ladder and buttonhole in clinic, versus both techniques at home?

[cassandra]

Jean you can do it!!! Is it poss to watch patients doing it? You have enough time to orientate the subject. Brilliant you keep'n eye on yourself. Love, Cas

[obsidianom]

Hi Obsi, do I understand that this study is a comparison between rope-ladder at home versus buttonhole in clinic? Or rope-ladder and buttonhole in clinic, versus both techniques at home?

This study took 90 patients ON HOME HEMO (self cannulators) who started out on rope ladder and then after time were switched to buttonhole to study. The study looked at about 4 and a half years on each as an average.  So this was all done on just the same patients at home doing both techniques. This is the first time I have seen this type study utilizing the same at home patients for both techniques.

Botton line to me was first it proved what I have been saying and writing that the fistula is NOT damaged by rope ladder or sharp cannulation over time. A lot of people used to claim there would be more aneurisms and damage with sharp rope ladder . This simply does NOT occur. Again this is at home by the same person each time , not clinic staff. I dont think it would be as good with different techs each time but I cant prove it.
Wolfs Law indicates the tissue as stressed by the constant use of sharp punctures will heal stronger . I see that myself in my wife. After a year of rope ladder sharps 5 days per week, I notice a definite change in the fistula tissue. It is much stronger and tougher now . I have to push harder to get through it. There is increased collagen clearly occurring. (I was a surgeon for 15 years so I am used to feeling tissue and evaluating it for changes from normal , and I still evaluate tissue in practice externally by using my hands which have 25 years experience feeling for changes).

Now the other aspect is the fact that buttonholes are more prone to infection. That is again looking at the same 90 patients doing the cannulization on themselves at home using first the rope ladder and second the buttonhole. So this is not done by different people each time . There were simply more infections on these patients when they switched to buttonholes.

Now , do I think that buttonholes should be discontiued?    NO.   I think in the right hands they still are a viable choice  .  However  we should let everone know of the increased risk of infection and potential consequences before they start. Then they can make an informed choice.

For the record I switched from buttonholes to rope ladder when we got an infection after a month. I used very careful technique being a surgeon and I still had an infection. Since we switched I have been much happier and have less stress not having to worry about infections and scabs etc. I do use short needles as I wrote earlier  (3/5 inch) which reduces the risk of infiltration and damage to the fistula.

For those who are successful with buttonholes , I commend you for obviously doing it right. Keep up the good work. For new people who havent yet begun, you will ahve to weigh the evidence and the pros and cons of both techniques. Nothing is perfect.

[amanda100wilson]

Jean why not ask the staff if you can have some needles so that you can take them home and get used to just handling them first?  You may want to go to Home Dialysis Central and look up Stuart Mott's information on Touch Cannulation or just Google it?  Try to familiarize yourself with it beforehand and I am sure that it will help.  Honestly, it is not so bad, it really is a case of just going for it.  It is so much better than having someone else doing it for you. 

[Jean]

LOL, now, why didn't I think of that??I will ask my renal nurse for some and I was just thinking, maybe I should start Googling. But, thanks for the encouragement Amanda and the good advice Obs.