Question for Buttonhole users

[JeanieSpokane]

I recently got my buttonhole established, after trying to do it myself - then a tech devoted her time (and still does) to establishing new buttonholes.  Once, though, she was gone and another tech tried to do it - but they couldn't get the venous - so tried a sharp away from the established site, but infiltrated.  Then the swelling went down to my arterial and it stopped functioning and I had to go home and come in the next day and was able to do my buttonholes.  However, I had trouble holding off at the end.  After a couple attempts, I ended up holding for 60 minutes.  I have been holding my sites for 25 minutes ever since - cutting that to 20 minutes last week, and hopefully to 15 minutes next week.  Do you buttonhole people have to hold longer than non-buttonholr?

[Pam]

I've been using the same buttonholes for over 2 yrs. I only hold mine for 5 min. Yhey change the gause and tape them up. When I get home and remove the tape and gause there is only a pin prick spot of blood and today there was non at all.
Pam

[YLGuy]

I have buttonholes and have to hold for less than 1 minute.  I leave the bandages on for1 hour afterwards JIC.  How much Heparin are you getting?

[Desert Dancer]

Do you buttonhole people have to hold longer than non-buttonholr?

I generally only have to hold mine for 2-3 minutes. I think I'd second YLGuy's question: how much heparin are you getting?

[Lindia]

My hubby was having bleeding, and they think it could be his fish oil.  He has HIGH triglicerides and was taking 6,000 units,  he's cut back to 4,000 and the bleeding is less, but he does need 6,000 - so its tricky.   Just one more thing that can thin your blood.

[mcclane]

I'm in the process of establishing a button hole.  At the very beginning, they used sharps, and I had to hold the site for about 10-15 min (there are 2 sites), so in total i had to sit there for about 30 min holding 2 holes.

Now that I'm using blunts, both take less than 5 min each.  Once you move to sharps, the bleeding take minimal time to stop.

[michele]

I've used buttonholes since late 2008. I have had minimal problems with them. I rarely hold my sights for more than 3-4 minutes. My heparin is stopped the last 30 minutes also. I've never had any problems after I get home with bleeding. I apply regular bandages on the sight, followed by a gauze 2x2 pad folded in thirds taped over the bandages. the gauze comes off after an hour, but the bandages stay on overnight (JIK).  I was told to do this to help prevent problems with the buttonholes. Hope this helps-love hearing how others are dealing with the day to day challenges of dialysis!
PS-Im headed to Mayo in MN next month for my evaluation. I had been listed with Swedish Med in Seattle, but felt like I was getting the runaround from them...been on the list for 8 years now...hoping a new kidney/new life is in my near future! God Bless everyone who makes this site so wonderful, funny, and educational.

[tyefly]

When I started in center I was getting alot of heparin...... roughly 8600 u  for a three hour run... I didnt know any better.....  then when I started Nxstage at home I reduce my heparin use and ran for 4 hours daily and used 6000 us and then down to 4000u...  back when I was in center I was holding my sites for 15 to 20 minutes and beggin for no blow outs......  Then when I went home I only held my sites for well maybe 3 to 5 minutes.....mostly 2 minutes with venious a few minutes more with the arterial....   I believe its all about the heparin use.....  we dont need that much heparin....  I was running nocturnal home hemo at Blood speed of 300 for 7 hours and I think I clotted the machine two times....that was it....for well over a year..... I established buttonholes after 6 fresh sticks in center and have been using those same buttonholes for almost two years.... I would review the heparin use........ I dont believe it a buttonhole issue..... many fresh sticks have to hold too long in my opinion incenter because of over use of heparin......  note....side effect for me while using heparin was hair loss... I have loss 50% of my hair.......  there are risk while using heparin..... look it up.... we want to use the least possible get the most benefit we can...... 

[Stoday]

I hold my buttonholes for 2½ minutes. Once a month or so, I have to start over because the 2½ minutes was not enough.

Heparin stops 30 minutes before the end.

Plaster left on for 3 hours.

[Hazmat35]

I generally hold mine for 2-3 minutes and then I am done.  There is a lady @ our center who holds hers for over 1/2 hour and sometimes longer.  I've seen her hold it for 1/2 hour, get tapped up, leave the center, and then come back, covered in blood where it started again. 

[JeanieSpokane]

Thanks everyone!  I cannot believe most of you hold for so little time!  I tried to cut down to 15 minutes and had to hold for another 10 Wednesday - so opted to hold for 20 on Friday.  They cut my Heparin down to 5000 (I think) and cut off an hour before I'm done (I do 3.5 hours).  I'm going to research the Heparin thing.  Thank you all so much!  I really appreciate it!  Also - what is your average flow rate?  Mine is 400 and for some reason - the last couple of times, the arterial flow has "shot way up" and starts up the alarms.  Sometimes, if they pull the needle out just a hair, it will adjust.  I need to research that, too.  Again, thanks a million!

[Desert Dancer]

Thanks everyone!  I cannot believe most of you hold for so little time!  I tried to cut down to 15 minutes and had to hold for another 10 Wednesday - so opted to hold for 20 on Friday.  They cut my Heparin down to 5000 (I think) and cut off an hour before I'm done (I do 3.5 hours).  I'm going to research the Heparin thing.  Thank you all so much!  I really appreciate it!  Also - what is your average flow rate?  Mine is 400 and for some reason - the last couple of times, the arterial flow has "shot way up" and starts up the alarms.  Sometimes, if they pull the needle out just a hair, it will adjust.  I need to research that, too.  Again, thanks a million!

Holy Mackerel!    That seems like a lot of Heparin for 3.5 hours! I'd take a look at the Heparin rate on your machine and see if they can't start edging it down a tenth at a time. My doc gave me free rein to adjust my own Heparin; when I started out I had an initial bolus of 2000u (still do) and 1500u per hour, stopping the last hour. I adjusted it down to 1400u, then 1300u, then... you get the picture. When I got to 1100u the dialyzer had clots in the top and was pretty streaked after the return, so I bumped it back up to 1200u and that's where I've been ever since. My Heparin pump dispenses a total of 9600u and it lasts me for 10-11 hours. That's not even twice the Heparin you get and you dialyze only a third of the time I do!

My flow rate is low because I'm on nocturnal (250 blood flow, 300 dialysate flow), but as to the alarms, perhaps you can try flipping over the needle after it's in? My fistula is shallow, so I have to flip both my needles or the bevel sucks up against the fistula wall. I've never had a single alarm once I started doing this.

[Hazmat35]

Thanks everyone!  I cannot believe most of you hold for so little time!  I tried to cut down to 15 minutes and had to hold for another 10 Wednesday - so opted to hold for 20 on Friday.  They cut my Heparin down to 5000 (I think) and cut off an hour before I'm done (I do 3.5 hours).  I'm going to research the Heparin thing.  Thank you all so much!  I really appreciate it!  Also - what is your average flow rate?  Mine is 400 and for some reason - the last couple of times, the arterial flow has "shot way up" and starts up the alarms.  Sometimes, if they pull the needle out just a hair, it will adjust.  I need to research that, too.  Again, thanks a million!

I go for 3.5 hours and they cut my Heprin off 1 hour before!!!!! 

[JeanieSpokane]

Still having problems with the length of time holding my sites.  I hold them at the same time, for 20 minutes.  I've tried the last two times to stop at 15 - no dice.  I bleed like a stuck pig.  My Heparin bolus is at 3000, and they cut it off at an hour.  Still.  I've been reading about different pressure bandages - maybe I'll try that.  20 minutes is just way too long!  (And one of the solutions the center is suggesting is to have a fistulagram because there may be some narrowing in my veins.  I do not want a fistulagram - and I really question that narrowing of my veins would cause me to keep bleeding - Thoughts?)

[Hazmat35]

20 minutues sounds like a long time.  I've noticed since you started this, that there are a few people at our center who have to hold each site for about 30-45 minutes each!!!!  And they take out the needles one at a time!!!!  If they don't, they bleed everywhere. 

Having a Fistulagram is not big deal.  I've had two of them, and it is such a simple procedure it isn't funny.  Last time there, I was talking with my Surgeon during the procedure, and he was explaining what everyone in the room was doing.  It took my mind off of what "HE" was doing, but all you feel is some heavy pressure once in a while.  If you need to have one done, I would do it!!!

[billmoria]

my button holes were established 3 years ago. my venus site has little or no pain. the other site has very little pain; less than a sharp needle used to have. my bleeding times are 3 minutes on each.

[CebuShan]

My button holes are still getting established (still using sharps) but already I have noticed that my holding time has dropped to 5 minutes.