Buttonhole technique...is it REALLY better?

[Sara]

I've been really impressed with what I have read here about it, and I've been talking to Joe about it.  My idea is that if he can do the BH technique, it will be one step closer to doing dialysis at home (we can't do it right now but maybe in the next year or so if he doesn't get a transplant by then), and I'm also hoping that maybe it will help him avoid any(more) aneurisms or bulgings in his fistula.  Plus it wouldn't be as painful.  So anyway, he asked somebody at the clinic today and was told the clinic frowns on it because it weakens the fistula in that one spot.  Is that true?  Are there any studies or anything proving that it is better for you?  Any papers or SOMETHING I can point his doctor/clinic to?

[Black]

Hope these will help.

Every dialysis unit SHOULD be familiar with the National Vascular Access Improvement Initiative -  More commonly known a "Fistula First"

See the last link under #8

http://www.fistulafirst.org/tools.htm

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If any of the nurses read the Journal of The American Nephrology Nurses' Association in 2002 they should have learned about the buttonhole technique

"...
Clinical Consult (Department)
Cleansing Agents Used for Hemodialysis Catheter Care, (6)599
Fistula Cannulation: The Buttonhole Technique, (2)195
Hypertension in the Hemodialysis Patient: Nursing Considerations, (1)71
Interventions to Promote Fistula Maturation, (4)377
The Link Between Dialysate and Chronic Inflammatory Disease in Hemodialysis, (5)490
The Use of Intravenous Immune Globulin to Reduce Panel Reactive Antibodies in Children with End Stage Renal Disease, (3)303..."

http://nephrologynursing.net/index/subj02.htm

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"...The initial experience with two methods based on almost ten thousand dialyses led to the following conclusions1:

Insertion into a previously-used site is easier and can be done very quickly, in less than 10 seconds.
Cannulation is less painful and anesthetic use may be eliminated.
Reinsertions of needles because of poorly performed sticks are virtually eliminated.
Hematoma formation is reduced more than tenfold.
The infection rate was not significantly higher than with different-site method of needle insertion. ..."

http://www.ishd.net/abstracts.php?article=20050422
 
(Note the mention of the original study done in 1979)

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What Is The "Buttonhole" Technique Of Fistula Cannulation And What Are The Advantages?
The buttonhole technique of cannulation involves inserting the needle (or cannula, as in the case of Nocturnal Hemodialysis) through exactly the same hole every time. This makes success of the cannulation predictable, and after a few insertions there is no pain involved. Although cannulating in the same area of the fistula can be a cause for fistula aneurysms, there is some evidence that the "buttonhole" technique involving insertion in exactly the same hole prolongs the life of the fistula. Results over the last three years have been excellent. 

http://www.renalweb.com/guest/lit/mwilliams/FAQs.htm

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A Canadian Study currently underway - 1/06 to 1/07 

http://www.controlled-trials.com/isrctn/trial/%7C/0/94795553.html

[Epoman]

I've been really impressed with what I have read here about it, and I've been talking to Joe about it.  My idea is that if he can do the BH technique, it will be one step closer to doing dialysis at home (we can't do it right now but maybe in the next year or so if he doesn't get a transplant by then), and I'm also hoping that maybe it will help him avoid any(more) aneurisms or bulgings in his fistula.  Plus it wouldn't be as painful.  So anyway, he asked somebody at the clinic today and was told the clinic frowns on it because it weakens the fistula in that one spot.  Is that true?  Are there any studies or anything proving that it is better for you?  Any papers or SOMETHING I can point his doctor/clinic to?

Yes it is, did you see this thread? http://ihatedialysis.com/forum/index.php?topic=965.0 download the .PDF to answer all of your questions, many doctors are "OLD SCHOOL" and are afraid of admitting they were wrong about the buttonhole technique all of these years. It has been proven it is better that is why NOW finally Davita, Kaiser are switching over to buttonholes. I am speaking from experience I love it and can't imagine going back. Many nurses and techs have no idea what a buttonhole is, at my old Davita, NO one even knew what the hell I was talking about.  and that really saddens me because it would stop so many of patients problems when it comes to their access.

[Panda_9]

I definitely think it is the way to go. I wouldnt have it any other way.

[angieskidney]

I watched a man on dialysis first hand pick off his scabs and stick the blunts in. He explained it to me when I asked about it and highly recommended it and told me it would be beneficial for me considering all the scar tissue I have in my arms. I want to learn it and plan on it. My dialysis nurses even told me that if I am too scared to cannulate myself they can still do the button hole FOR me


edited: spelling mistake ... thx Epoman for .. uh ... pointing it out to me

[Epoman]

I washed a man on dialysis first hand pick off his scabs and stick the blunts in. He explained it to me when I asked about it and highly recommended it and told me it would be beneficial for me considering all the scar tissue I have in my arms. I want to learn it and plan on it. My dialysis nurses even told me that if I am too scared to cannulate myself they can still do the button hole FOR me

You WASHED a man 





 

[Panda_9]

Thats great angie!!! Hope it all works out for you. Maybe when they get them established you can have a go at it yourself. It might be a little hard at first at getting the angle right (that someone else has created), but you'll soon get the hang of it. If not well then thats great they have offered.

[angieskidney]

Thats great angie!!! Hope it all works out for you. Maybe when they get them established you can have a go at it yourself. It might be a little hard at first at getting the angle right (that someone else has created), but you'll soon get the hang of it. If not well then thats great they have offered.

Thx! I just wish I knew when they would teach me. It seems to be at the very bottom of their priority list