This is how we use 4 buttonholes

[Maggie and Jeff]

I have been sticking Maggie for over 2 years we have an AV fistula and stared using the buttonhole technique from the start.  This is Maggie’s first fistula we see the surgeon every 6 months.

  Staring a new buttonhole

This is how I do it:
 
The needle must be put in the same spot in the vein each time for the first 3-4 weeks so that a tunnel will form from the skin to the vein.   


First use sharps of the size you want the final hole to be for 5-6 consecutive days. 
The consecutive days are very important!!!!

Dulls, for the next 6 days, it's best if you don’t take a day off (but we do some times) for the first 12-14 days. Once the buttonhole is established you will always get the needle in and if done correctly you will not need to use a sharp until you need a new buttonhole.

Now the buttonhole can be used every other day but do not skip more than 3 days until it’s been 4 weeks.

We use 2 sets of buttonholes 2 venous and 2 arterials that way each set gets a day off .  We have been able to use each set for about 6-8 months before we needed to move due to the fistulas size getting bigger in that area.
For example: Tops one day

V<
V
A<
A
Bottoms the next day

V
V<
A
A<

When we start the second set we establish one at a time, that way I use the new one every day and the established ones every other day.  I prefer to place the needle so it can be used as an arterial or venous this is helpful when staring a new buttonhole.

We do not use sharps after the first 4 weeks on a buttonhole (sometimes I use 3 or 4 buttonhole needles trying to get it in).  If it will not go in and I have tried several times I start a new one in (hopefully) a better spot.

Remember to check with your vascular surgeon to find out if the buttonhole technique is right for you.

I hope this helps someone

[monrein]

That's really helpful to me Jeff and I'm going to print it out to take to my centre.  We're going to start establishing buttonholes soon.  I go 5 days a week but not the weekend so those 2 days off should be OK I think.

[Maggie and Jeff]

Happy to help 

[del]

Hubby just has 2 buttonholes.  We use them all the time.  He does 3 nights on , a night off then 2 days on a night off. if something happens to one of the button holes we just establish a new one. His venus buttonhole we have been using for about a year and a half and the arterial for about a year. 

[G-Ma]

Great info Jeff.  My vein rolls, slips and slides so much that I've pretty much given up on a buttonhole but the surgeon that did my fistulagram took a picture of the vein showing my sticks and said I have a very good ladder going so that's what I'll keep doing.

[BRANDY]

I also printed this buttonhole tech. I am doing research for when I have to get on dialysis ,thanks