Buttonhole

[roskidney]

Hi everyone, I would like to ask about the blunt needles used. Do these needles only come in the 15 gauge size needles or do they come in different sizes (i.e. 16 gauge)? The reason I ask is because our clinic is starting to go with the buttonhole technique and I would like to do it but my treatment goes better with 16 gauge needles.

Thanks for your help,
Ros

[GraphicBass]

Buttonhole needles come in several sizes and lengths. With me, they started off with the smallest gauge and every other session changed to a larger size. I believe I ended up with the 14 gauge; most others had a 15. Ask them to start small and short until the get a handle on how much length is needed. Best if just one or two techs do the needling until the buttonhole is established; insists on this if you can. As soon as the buttonhole is working properly, get trained to do it yourself.

g

[fearless]

thank you for this question and answer, and ANYTHING that anybody wants to say about establishing buttonholes.  I am hopeful to go in that direction myself.

[mcclane]

I had my button hole established this summer, but I lost one (I had 2). 

I remember they first poked me with an 18 g sharp, and that lasted about a week or so.  Then they moved to semi sharps (slightly bigger needle), and that went for another week or so, and then finally blunts (15G).  The key to buttonhole creation is that the same site has to be poked everyday, as you don't want the area to heal.  Eventually what happens is the area became 'hardened' (ok, i know that isn't a medical term), so when you jab yourself with a blunt you really don't feel anything.  If you do, then you didn't get it in the track.

I have found that to successfully penetrate the buttonhole, you have to have all the angles exact each and everytime.  You have to sit the same way, have the arm in the same way, every time.  If you're off a little bit, it is like finding a needle in a haystack.

[fearless]

I am on hemo and have been using a neck catheter, although I have a nice fistula ready to go.  Problem is: twice they've tried to stick me, and twice I've infiltrated.  And the one that's healing now is outrageous.  So, i am hoping to do home hemo, and establish buttonholes.  Should i let the nurse in-clinic help me establish them?  Or should I simply plan to do that on my own?  (I know it's an opinion question, not medical advice, so please say whatever you think)

Because my fistula is still pretty much unused, I have the opportunity to do this right (thanks y'all) and so am eager for anyone's experience / advice

[mcclane]

I'd let the nurse establish it for you.

with mine, they first stuck me with sharps, and they also encouraged me to stick myself with a sharp too.  I only did it once or twice, I still have a problem of not going 'fast' enough (that's when I almost squirted the nurse with blood using a sharp because I went too slow).

Eventually, when we got to semi sharps, they had me stick myself, as the button hole was beginning to form.

I'm ok with blunts now, but honestly, I'm not sure if I can stick myself with a sharp.

[fearless]

thanks mcclane

[amanda100wilson]

One person and one person only should establish the buttonhole.  If you have a shallows fistula, reccomend you ask for 5/8" needles.  Much better than 1" ones for this.  My nurse was sceptical but I insisted.  Now he's using them on someone else too.

[fearless]

so grateful to (and for) all you smarties!

[mogee]

For six years, until my fistula failed, I had ten buttonholes along the length of my fistula.  I used a different set each time I dialyzed, dialyzing five times a week.  A 16 gauge needle is smaller than a 15 gauge needle and will cause a higher venous pressure at a given pump speed.  Using a larger gauge needle (i.e. a lower number) will cause longer bleed times, and possibly uncontrollable bleeding.  A thinner needle will cause higher venous pressures.

Have you tried Supercath, a plastic catheter with a steel needle "introducer" that is removed once in place?  Unbelievably comfortable and no risk of penetrating the fistula.

[boswife]

whoh there Mogee.... what is this Supercath you speek of???  Going to bee looking it up but would love to hear more from YOU....

[fearless]

I think I did see something about that somewhere...what I don't understand is why hasn't something like that been used all along?  Why do we have to have a strait needle with a sharp point stuck in our arms for four hours?  IV's use a little plastic catheter, don't they?  It really bothered me when I started hemo, and one of the first things they told me was to expect that it would take a while and some infiltrations before things would start to go right...why should we "expect" infiltrations?  There's got to be a better way. 

[mogee]

I will try to post some photos of supercath although I now have a CVC and no longer need them.