Having Problem With Buttonhole.

[jg]

Had a fistula put in late March.
Started home daily hemo training in May.
In the second week had a blow which heavily swelled my  arm.
Without pd and no catheter, I had to keep dialyzing with the fistula in my upper arm. My arm is still healing 2 months later.
I have 2 buttonholes, one about 1 inch above the elbow, the other about 5 inches above the elbow.
THe lower one is okay, but the upper is a big problem.
Whenever I or the nurses put the needle in, my arm spasms, the tunnel moves back and forth, and sometimes
the vein collapses. The nurses with their experience, wait and USUALLY get the needle in.
Now I am on my own at home.
The problem is, when I try that buttonhole using a blunt needle, I nick surrounding tissue, causing bleeding, temporary damage and a clot.
Then I have to use the lower buttonhole.

Any suggestions?  Start another buttonhole?  Have a catheter put in?  Keep trying that buttonhole?

   jg           
 

[silverhead]

I'm not sure I understand you completely, but just because you have buttonholes doesn't mean you have to use blunt's, you can use sharps if they work better for access, also, you can move your buttonhole location at will if it means better, easier and less problems with the access.....

[Rerun]

 

[natnnnat]

The following comment was sent to another forum, I reproduce it here with permission from the gentleman who wrote it:

Over the three or four years that I have been using the buttonhole technique, I have had cause to create a small number of new sites, perhaps four or five.  Had I known in advance that I would need to resort to this, I would have planned the placement and hole direction with much greater care and given more thought to the layout of future holes, should that be needed.  If it is necessary for you to take this path, think about where you should place future buttonholes.  It is probably best if you can keep your tracks parallel to each other so that the tunnel of one needle never intersects with the scar tissue on one of your other sites. 

[mogee]

I had a great deal of difficulty with my fistula at first.  I required an additional four weeks of in-centre at the end of my training because my fistula was so crazy.  I suffered venous spasms lasting up to 45 minutes, with venous pressures around 300.  My fistula wall was frequently punctured or scraped.  At one point I was ready to quit and get a central line instead.  My fistula has been working OK for the last five years.  I need frequent angioplasty to keep it sufficiently open (about every 2-3 months), but my cannulations are good.  I have 10 buttonholes and I use each buttonhole once a week.  They are 1cm apart.  I have never used blunts.

[Trena]

I totally understand. I'm having problems with my upper hole, veinous, also. If I stick too high it clots the needles just as soon as I get them in. There is a spot less than a cm lower that seems to work well, except for yesterday!

[Bruno]

I seem to clot very easily so we have been trying a little heparin in with the saline when we flush back immediately after cannulation. We then lessen the amount we bolus after hook up. It's been working well.
The other thing we tried was was not to fully insert the needle for a session or two whilst the clot worked its way further into the system.
Worked well but you can't move your arm and need to adjust the system...slower pump speed etc.
Finally, we missed a session..again to give the clot time to move.
The combination of these things did the trick...we saved the access, eventually got the needle fully inserted and am now almost ready for full buttonhole and blunts.