Noob Questions...

[wrandym]

Like I have said before-I am starting from zero, but reading a lot here.  I have 2 words I would like defined, please:

buttonhole and infiltrate


I feel like an um-duh

Edited: Fixed subject line-Boxman,Moderator

[monrein]

A buttonhole is for hemodialysis when you go in the same exact hole each and every time.  It becomes like a permanent tunnel and we use a blunt (not sharp) needle.  Supposed to be easier on the fistula.

Infiltrating is when there's a problem with a hemo needle and it isn't right in the vein so blood leaks out of the vein into the surrounding tissue and causes nasty nasty bruising.

[nursewratchet]

Dialysis 101, here goes...

 Buttonhole is a site in your Fistula that is used every single time, in exactly the same direction.  It ends up being like a peircing, or buttonhole.  The same person needs to cannulate that every single time, until it is well established, and thereafter if possible.  The buttonhole works longer, hurts less, and lengthens the life and side effects of the fistula.  

Infiltration is a site when during cannulation, the needle went "through the wall" of the access.  the blood will then leak out of the vein and into the surrounding tissue.  It is painful, you will be badly bruised, and it can be very dangerous, andif not watched closely, could cause the loss of the arm.  It can happen either with poor "sticking" technique, or if you move suddenly while the needle is in your arm, or if not taped properly.  If you get an infiltration, the nurse should outline the area ( it will hard and swollen) with a permanent marker.  Keep an ice pack on and off for about a day.  Watch VERY closely the area that is marked off.  If, after you are home, it gets larger, go to theDialysis center, or Hospital.  THAT is a medical EMERGENCY...

  Hope this helps.  Don't worry!

[petey]

As a teacher, I tell my students, "The only 'dumb' question is the one you have but don't ask."

Here are my layman's definitions for these words:

buttonhole -- this is a method of cannulation used with fistulas (don't think it will work with grafts), and it's where you stick the needles in repeatedly in the exact same spot.  As you stick over and over again in the same spot, it forms a "track" from the outer skin to the access itself.  As it was explained to us, it's like the opening for a pierced ear (except that on the other side is the fistula).  We were told that it extends the life of a fistula.  My husband Marvin has buttonholes (one for arterial and one for venous) that he's been using now for almost 17 months.  It's funny but when he first started on hemodialysis 14 years ago, the theory was NOT to stick in the same spot; things do change over time.   With a buttonhole, you use "blunt" needles (as opposed to sharps) so it's not too rough on the fistula and it doesn't "tear" the track as you're going in.  Buttonholes, I believe, last longer if the SAME person cannulates (sticks) every single time.

infiltrate -- during cannulation, when you go into the fistula or graft on one side with the needle and you stick all the way through and out the other side.  It's painful, as the blood actually infiltrates into the surrounding area around the fistula and/or graft.  Usually, swelling and bruising occur, and it requires a re-stick for that session.  Marvin has been infiltrated with both a graft and fistula on numerous occasions when he was in-center.  Now that we're on home hemo, I haven't infiltrated a single time (knock on wood!), but this is one of my biggest fears (as I'm his "sticker").  Now that we're using blunt needles, our home hemo training nurse said it was NOT possible to infiltrate with this type of needle; however, I don't think I believe that.  After all, if the blunt needle can go into one side of the fistula, surely it can go out the back side, too.  (I don't believe all the home hemo nurse says!)

[nursewratchet]

Petey, you can infiltrate a buttonhole, though it is not nearly as difficult.  If it happens, the same needs to be done about it.  Read the above trail. 

[nursewratchet]

Petey, you can infiltrate a buttonhole, though it is not nearly as easy.  If it happens, the same needs to be done about it.  Read the above trail.  

[nursewratchet]

OOPS, I'm a moron.   

[wrandym]

Abyssus abyssum invocat

thanks for the quick answers.  I have another question and I feel dense.  In my line of work, we have a joking philosophy that there are no stupid questions, just stupid people.  It gets us through the day.

what is a graft?

Also...the self cannulating thing.  Umm-not a fan of thinking about this now.  I have been a diabetic for 26 years and have no problems sticking myself with a needle for that...but that is differeent!  I am sure that when my fistula heals and I get used to all thiss it won't be so "different".  This is my new life...

[nursewratchet]

A graft is an artificial access.  Usually a Bovine (cow) vein.  It can be synthetic though.  Sometimes called a Vectra graft, or a Hero graft.  All different types.  The most common is the Bovine.  Fistulas are always best , if your veins are good enough to warrant it. 

[monrein]

wrandym, when you are ready to talk about "the self-cannulation thing", please talk to me because I AM a big fan of it.  You are the one person who will always be present at your session, so there's the best built in consistency there is and the best thing for a healthy fistula is consistency.

[wrandym]

thank you monrein-I will 

[Run8]

Wrandym, the self cannulation get very easy after time and i don't think i would let anyone else do it. i am very protective of my access arm.it is a "no touch Zone". I chose to have a synthetic graft put on.

[petey]

Petey, you can infiltrate a buttonhole, though it is not nearly as difficult. If it happens, the same needs to be done about it. Read the above trail.

Thanks, nursewratchet -- I knew I was right.  You just can't tell Marvin's home hemo nurse anything.  He thinks he knows everything, and when it's obvious he doesn't know an answer, he makes up one.  Marvin and I don't believe him half the time.  He's an idiot -- but he's the only home hemo nurse around, so we have to put up with him.

Also...the self cannulating thing. Umm-not a fan of thinking about this now. I have been a diabetic for 26 years and have no problems sticking myself with a needle for that...but that is differeent! I am sure that when my fistula heals and I get used to all thiss it won't be so "different". This is my new life...

wrandym -- My Marvin has been on hemo for the better part of 14 years, and he still can't self-cannulate.  He doesn't even look when the needles go in.  Some people can do it, and others can't. 

[BRANDY]

What exactly is a graft   what do you do with it    i suspect to dialize  with   but  this is new to me   I have heard of fistula more  Noone says anything about  graft    which is better   correct me if Im wrong on this   Im very curious   

[jbeany]

A graft is an artificial fistula.  If the patient's veins are too small to make a regular fistula, the surgeon can use a type of nylon tubing to make the loop between artery and vein.  They are not as good as a regular graft, since the tubing wears out from needle sticks.  The average lifespan of a graft is about 1 year.  (I've been using mine for two, so that's not a given.)  Still, it's better than having a chest cath in terms of infection risk.

[Run8]

So what do I have, a graft or fistula. My fistula is at my wrist, about 2 1/2 inches above the wrist I have synthetic tube. My veins to make the loop, tube for the sticks.

[nursewratchet]

Is it "in a loop" or kind of staight, a little squigly?  If there is a true "loop", it's a graft.  The staff at the clinic can tell by looking at it.  Sounds like a graft, porbably Bovine. 

[Run8]

I started off with a fistula, but the vein only widened(or what ever you call it) about 2 inches from where they connect it to the artery. From they they took out my vein and used Synthetic not bovine. they didn't use anytube to make the loop.

[petey]

Is it "in a loop" or kind of staight, a little squigly? If there is a true "loop", it's a graft. The staff at the clinic can tell by looking at it. Sounds like a graft, porbably Bovine.

Marvin has a fistula now ( I say "now" because he's had other grafts and fistulas before).  When he ran out of places to put an access, his surgeon (the greatest surgeon in the world) made him a "magic fistula" (as we call it) because the only other option was in the leg.  This surgeon took a vein out of the back of Marvin's arm, flipped in around and to the inside, and then strengthened it with another vein moved from the leg up to the arm.  When all was said and done, Marvin's magic fistula was in the shape of a loop (a big "U").  There is nothing artificial in there -- it's all Marvin, just from different parts of his body.  ALL THE TIME, we have doctors, nurses, and techs say, "Oh, that's a graft because it loops."  To which we say, "No, it's a fistula because it's all natural."  We had one nephrologist at the clinic argue with us that it HAD to be a graft because of its shape.  It is shaped that way because of the way the surgeon put it together.  Marvin has been using this particular fistula for four years now -- the longest he's used any access  .

By the way, Marvin calls his surgeon "Dr. Frankenstein" because he keeps piecing Marvin back together.  The surgeon calls Marvin his monster.  It's all said in joking.  This particular man has saved Marvin's life numerous times over the last 14 years, and he has also done things that no other surgeon at Duke Hospital thought would be possible (like the magic fistula).  He's creative, innovative, intelligent, extremely skilled, and very caring.  We love him -- we absolutely love him, and we thank God for him every night.

Not all loops are grafts.

[nursewratchet]

True.  If you have a great surgeon, the fistula can be wherever, in whatever shape he places it.  My mistake...

[Budluv]

Is it just me or does the word buttonhole make you laugh.