Taping Access Site

[PrimeTimer]

Question:  Do you tape "over" the needles (the hub or any of the silver part) or just the wings? And please let me know if you are using the Buttonhole Method or not. Thanks.

The reason I ask, is that I could swear I was trained NOT to tape over the needle hub/silver part but recently when our nurse was establishing a new Buttonhole for my husband, she taped OVER the needle. I've been reading online that you should tape over the needle so that no bacteria can seep down onto the needle and creep into your blood. But...while I understand the importance of taping OVER the needle, my concern is that when you go to pull the tape off, you end up moving and/or pulling on the needle as well and that it could cause damage or widen the mouth of the Buttonhole. Make sense? I've been taping over my husband's needles but can't say I like doing that. Anyways, thought I'd ask what everybody else is doing.

[noahvale]

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[obsidianom]

We do sharps on rotating sites. I never tape on the needle , just to the hub. I tape over the wings. I do put a sterile 2 by 2 guaze over the hole and tape it down . This way it comes off without pulling on the needle. I dont see how any bacteris can go down easily anyway as the skin seals up the holes on sharps. Buttonholes are different as the hole doesnt seal the same. I just dont like buttonholes.

[Simon Dog]

I like buttonholes, but then, I have not yet had an infection.    I do the same thing you do - gauze over the needle/skin gap.  With buttonholes, it is important to leave a bit of the needle showing so the hub does not turn the buttonhole into a concave crater over time (google for Stuart Mott's paper on "hubbing the needle" for details).

[PrimeTimer]

Thank to those of you who have replied. I am going to continue taping over the needle where it enters the Buttonhole, we might use that gauze technique some of you use to prevent a "pulling effect". Makes good sense to me. My only concern with that I guess is that because my husband is a hairy guy, I would not want to trap any hair or have moisture form under the tape or gauze during a 3-4 hour treatment. Perhaps (and feel free to tell me) I am being too paranoid. We don't want to shave him or use a hair removal cream either, because we do not want to risk anything that is emollient that may carry bacteria down his Buttonholes. (and yes, we've read a lot on Stuart Mott's method, love it!).

My husband self-cannulates and has gotten pretty good at it (in like butter, as they say). For my part, I just simply guide his hand to the entry of the Buttonholes. Not long ago, he was hospitalized for a staph (aureus) infection but, they said the Buttonholes were not infected however, it was a "blood borne" bacteria. Well, I didn't think the Buttonholes were infected but the bacteria had to have entered from somewhere...?? They kept telling us not to beat ourselves up over it, that the bacteria he had is found everywhere on your skin but still...how it got into his blood we will never know and infections are scary and can be life-threatening. While at the hospital, he had to have dialysis but he was too out of it to self-cannulate and the nurse on-duty did not know how to cannulate Buttonholes -so I cannulated him! This is where our teamwork at home paid off. For the very first time I ended up "sticking" him and...didn't infiltrate! But whew! I was so nervous but him being in the hospital with a raging fever like that was scarier. He needed dialysis and we had no time to waste.

By the way, when I took him to the hospital, I took along my "clamp and cut" kit with all the supplies I'd need for a home hemo setup in an emergency and well, it was an emergency! My kit contains: blunts, sharps, gauze, tape, alcohol wipes, chucks, tourniquets, syringes and even Heparin!). The staff at the ER was very surprised and I might say, impressed. What was sad tho, is that altho they had heard about "Home Hemo", none had ever met a patient who actually does it and self-cannulates, nor did they know what a NxStage Cycler is. Even the vascular surgeon on-duty admitted he never met a patient who self-cannulates. That was disappointing. This should not be "new" to medical staff. On a positive note tho, we had a lot of staff members stopping by asking questions, saying they wanted to hear and learn all they could about this thing called "Home-Hemo" and NxStage. We were glad to talk about it and glad that there are those in the medical world who DO want to know and learn about it.

Long story getting longer...if you are a Care Partner and your loved one ends up in a hospital and especially if they end up needing dialysis while in a hospital, please insist that they allow you to accompany your loved one and assist, just like you do at home. Fortunately, the hospital where my husband was allowed me in and to do everything just like we do at home (except I did not make the blood line connections or setup up their BIG machine, as I was not familiar with it). The nurse was very nice but I did have to beg her to back off on things when my husband's BP started dropping very very low. She just kept saying she would have to call the doctor to see what they wanted to do about it, as if there was some choice! THAT was VERY upsetting...when someone's BP is dropping like that, there is no time to make phonecalls to the "boss"....I begged that she give him a saline bolus and take him off the machine but nope, she just HAD TO call the doctor first and sure enough, he started puking and only until then did she take him off. He's never puked or passed out, not even when he was doing incenter. That was inhumane. Once we got him cleaned up and stabilized, I walked away for a few minutes to be alone to have a quiet breakdown. Anyways, please stay by your loved one's side if you can and for as long as you can if they ever end up in the hospital. You need to be their voice, their advocate, their bodyguard because even then, things can get ugly. Go in being nice, remember, hospital staff have an enormous responsibility and work very very hard but, don't be afraid to speak up and be firm if you must and definitely go in...prepared.

Thanks again for all your replies! And for letting me share our experience at the hospital. We obviously fear infections AND hospitals!

[obsidianom]

I entirely agree about being prepared and doing as much hospital care as possible for your partner. I do the same for my wife.
Whenever she needs to go to the hospital we have a rule that I stay in the room the ENTIRE time . I get my own bed and "bunk in" with her. I do most of the nursing care and bring many of my own supplies. Her feeding tube and dialysis are complicated. I once stayed 3 weeks in the hospital with her. Since she doesnt eat real food they fed me instead. Hospitals are bad places to be left alone. I have caught several potential lethal errors each time with meds and orders. I check every med and order my self.
Its interesting that when switching to the big hospital machine your husband felt sick. It again proves how much gentler Nxstage is to the body.

[iolaire]

My only concern with that I guess is that because my husband is a hairy guy, I would not want to trap any hair or have moisture form under the tape or gauze during a 3-4 hour treatment.

I've been shaving around my fistula so I don't have to deal with pulled hair well in center.  Is there any reason not to do that to make the site smooth and clean?

[Simon Dog]

This should not be "new" to medical staff.

I have had people with MD on their nametag at the hospital tell me they were not aware anyone did hemo at home.

[PrimeTimer]

I entirely agree about being prepared and doing as much hospital care as possible for your partner. I do the same for my wife.
Whenever she needs to go to the hospital we have a rule that I stay in the room the ENTIRE time . I get my own bed and "bunk in" with her. I do most of the nursing care and bring many of my own supplies. Her feeding tube and dialysis are complicated. I once stayed 3 weeks in the hospital with her. Since she doesnt eat real food they fed me instead. Hospitals are bad places to be left alone. I have caught several potential lethal errors each time with meds and orders. I check every med and order my self.
Its interesting that when switching to the big hospital machine your husband felt sick. It again proves how much gentler Nxstage is to the body.

The nurse at the hospital ran him at a low BFR like we do at home BUT...I remember they wanted to take WAY MORE off of him than we normally do and I kept telling the nurse that, which brings up another suggestion...One thing that I did not take with me to the hospital that I wished I had, was his treatment logs reflecting what his dry weight usually is. For the life of me, I had a hard time remembering exactly what it was (I guess because I was stressed out so had a mental block). My suggestion: don't forget treatment logs/health history! I had the sense to throw all his medications into a cosmetic travel bag I have but forgot his dialysis treatment history! And hopefully there won't be a "next time" but if there is...I will take your advice and insist on staying at the hospital with him. I remember closely watching the staff and people coming/going and could not believe the cross-contamination and lack of overall "common sense cleanliness" going on. I even had to stop a staff member to tell them "hey, that dropped on the floor. Do not pick things up from the floor and put them back on his table!". I'm the one who helped him shower and even took the swab cultures from places I won't mention but I did not want them handling him like just another piece of meat. What an ordeal! Guess I learned a lot from all the times I was with my mother when she had been hospitilized over the years.

[PrimeTimer]

My only concern with that I guess is that because my husband is a hairy guy, I would not want to trap any hair or have moisture form under the tape or gauze during a 3-4 hour treatment.

I've been shaving around my fistula so I don't have to deal with pulled hair well in center.  Is there any reason not to do that to make the site smooth and clean?

I'm afraid that shaving would "break the skin" thus, leaving an entry way for bacteria to enter the bloodstream and/or seep down into his Buttonholes. May I ask tho, how long you've been shaving your fistula and if you use Buttonholes? No infections? 

[iolaire]

My only concern with that I guess is that because my husband is a hairy guy, I would not want to trap any hair or have moisture form under the tape or gauze during a 3-4 hour treatment.

I've been shaving around my fistula so I don't have to deal with pulled hair well in center.  Is there any reason not to do that to make the site smooth and clean?

I'm afraid that shaving would "break the skin" thus, leaving an entry way for bacteria to enter the bloodstream and/or seep down into his Buttonholes. May I ask tho, how long you've been shaving your fistula and if you use Buttonholes? No infections?

I'm only seven months in and am still in center.  I've shaved since I started out of hospital dialysis,  I only need to clean it up about once per week.