Fistula's , button holes, perma cath's.

[KICKSTART]

Ok so i ve been doing dialysis for a good few years now, but as you know i do PD , so ive never really dipped my toe in the water as far as hemo goes (part of me doesnt want to go there) but , next week im having tests done to see if my PD is still adequate or not and if its not .. then its hemo i guess. So what i want to know is what are all these different things , the buttonhole , fistula etc . Which is best in your opinion , which HURTS the least! What do they involve ?    'knowledge is power!'

[YLGuy]

I am still new to this.  It has been very painful for them to access one side of my fistula.  I just got the EMLA cream and does help a little.  They use the ladder technique when accessing my fistula.  The tech today suggested that down the road I should really consider the buttonhole technique because it is less painful. I am very interested in seeing any responses from someone who has experienced both techniques. 

[silverhead]

I believe when you first start using a fistula it is important to use the ladder technique to help build up the strength (or toughness) and size of the fistula, and would guess that several month's of this would be best, after that you could start trying to establish both buttonholes. It is REALLY important to find a Nurse or Tech who has good hands at this, and make sure that only that person does your sticks in the beginning, or better yet learn how to stick yourself, because the needles have to go in at the same point and angle every time, to establish a pathway (read that as creating a "tunnel" to the fistula). It becomes easier and less painful to make the sticks once they are going well, I would guess 2-3 weeks of use should do it.
Pay attention now to the sites that do not hurt as much and try to set them as the buttonhole areas when you start them.

[del]

My husband has been on dialysis for 12 years - the last 9 years have been hemo.  He has an av fistula that was established in 2000 and has never had a problem with it..  When he was in center for 6 years he used the ladder technique.  He started home hemo in 2006. We then established buttonholes. He did not have any problems with needling in center and he said once the fistula was needled for a while the most time it hurt was when they used a spot that had not been used before.  He finds buttonholes painless.  In 3 years we have not had any problems with infections or anything like that.  He has 2 buttonholes and if they stop working we will just choose another spot on the fistula and establish a new one.

[monrein]

The first time around I did the ladder technique, doing my own needles in a forearm fistula...no troubles, five years of D that time.
Second time around I did buttonholes in an upper arm fistula.  I laddered for about four months again doing my own needles although I let the nurses needle me for about a month.  Then I established 2 buttonholes and used those for the 6 months or so till I was transplanted.  I used no cream or lidocaine, never have except for the first time ever but lidocaine stings like mad, to me hurts more than the needles actually, and also tends to make my vein shrink away (in the forearm that was).  I never bothered with cream because I find it important to feel where the needles are going, those sensations guide me and I'm concentrating so much anyway that it never mattered.  The most crucial thing for me about D is doing my own  needles because that little bit od control removes a lot of anxiety about whether my nurse is a good sticker or not.  The patient is the one person who's there every single time and that is the best consistency there is.  Just that little bit less dependency meant everything to me.  I did 2 1/2 hour sessions five times a week at a self-care clinic but only three of us did our own needles.  If you ever travel to another clinic it's nice to not worry about who will be sticking you as that used to be my biggest source of anxiety by far.

[OhioTech8Years]

from a staff standpoint, buttonhole sites are the way to go. these reduce the amount of damaging sticks your fistula will receive and they actually prolong the life of your access. most of my patients have them and say they don't hurt nearly as much as sharp needles. BUT..... PLEASE BE ADVISED..... only one tech is to establish the sites, which can take up to 3 weeks. if your tech is absent for the day while your sites are still being created, do not let anybody place a needle in or near your buttonhole sites. make sure that your tech is the most experienced at your unit to forgo any complications.

[YLGuy]

I have the one sensitive side... Today the tech must have dug around a little too much.  She stuck me a twice there but kept pulling it in and out trying to get a flash.  Tonight it is swollen and very sore! 

[pklipe57]

My fistula is in my upper arm.  The same tech stuck me everyday with sharps (about 3 weeks) and yesterday she used blunt needles on my buttonholes.  They slid right it.  I was so glad. 

The other good thing - is I got my catheter out last Friday. 

[YLGuy]

Well, I really messed up today.  The tech, trying to miss the nerve on my sensitive side stuck my fistula much farther up my forearm.  It was perfect. No pain at all.  About 5 minutes into my session I put on my headphones as I always do.  The needle infiltrated.  I felt a pinch and the alarm went off.  The tech turned around and asked me if I moved.  I told him what happened.  He had to pull the needle and stick me again.  We iced my arm on and off during my session but I am in a lot of pain right now.  My whole arm hurts and I can barely move my fingers.  My forearm is so tender.  Live and learn-put my earphones on before or ask for help. 

[YLGuy]

Black and blue from my wrist to my elbow now 

I talked to the tech yesterday about buttonholes.  He said that he will try and establish them for me and that once they are established that I can self cannulate.

[Hanify]

I asked my renal nurse about ladder/buttonholes yesterday when she was visiting.  (I do PD so we were way off topic).  She said that here they prefer ladder to buttonhole. 

[Bub]

I too have finally got button holes established and it does hurt much less, and stops bleeding quickly at the end of the session.  But it took several weeks to get them established.