working on buttonholes...and...whaa? Alcohol prep "rub" instead of sterile pick?

[fearless]

On Monday my tech stuck me in the spot we plan to create buttonholes.  On Wednesday she provided a sterile pick for me to remove the scabs from Monday.  Today (Friday) she said the clinical director had told her they didn't want to "waste" a blunt needle pack just to get a pick.  We rubbed and rubbed and rubbed each scab, trying to pull out the little scab from where it sat just below the level of the skin.

WTF

This is cheapness that HURTS!  Please somebody tell me how bad this is and why, (damage to the shallow vessel?  infection?)  so when i insist on having a pick on Monday I will have a comeback to the "no" I'm going to get before they relent to my insistence.

GRRRRR!

[lmunchkin]

Man, I do not do bottonholes, but sounds PAINFUL! Ouch.... Maybe others here can tell you something that will help!
Good Luck,
lmunchkin

[amanda100wilson]

That does not sound hygeinic to me.  If they were to get the medisystems needles, which the 5/8" needles are, they each come with a plastic pick.  Another justification for getting the needles you want?  You could argue that when you get an infection you will hold the Clinical Director responsible and will take legal action against her.

[boswife]

sooooooooooo wrong!!!  with the money that's paid to them FOR YOU, they best be setting you up better than that!!!

[Desert Dancer]

That sounds to me like an infection waiting to happen. How in the hell are you supposed to make sure you get every last bit of scab? How do you know you're not pushing pieces of scab into the buttonhole rubbing so vigorously? No. No. No.

My supply company changed their supplier for needles a few months ago and the 'pick' that comes with them is utterly useless. I might just as well try to pick my scabs with a child's wooden block. What I've done is save some of the picks from my old needles and I store them in a container full of Alcavis. Alcavis is the disinfectant used for catheters; it's a much stronger form of ExSept. That way I can keep them and use them over and over. I change out the Alcavis once a week.

I second Amanda. I'd definitely let them know they're going to be held liable if you get an infection and lose your access, or worse. There's no way this method is 'best practices'.

[JeanieSpokane]

My center gets the blunts with the plastic picks on them.  I also just started my buttonholes (around Sept 2011).  I have had to be aggressively proactive in my care because they don't have a lot of buttonhole clients.  I LOVE buttonholes.  Once established, they are virtually painless.  I'm all for that.  But I have had to request having the same tech over and over - and I've threatened to walk out and just not do dialysis when they had a tech I didn't trust.  Now, finally, they are giving me the same tech.  And she is following my request to use the "touch cannulation" method (holding the needle behind the wings and letting the buttonhole be the guide.  Today was the first day and the needles went in like I was made of soft butter.  Amazing!!!  Before, the techs were fishing and fishing and fishing - driving me crazy!  Also - i suggested that they pull the needles back out just a teense - and then I won't get that little dip where the scab can be hard to get at.  The suggestion to save picks is a good one I think.  I agree with this thread - our insurance pays a LOT of money for our treatments.  Mine is avg $4,000 a day.  You think they can throw in a plastic pick.

[cattlekid]

Have you ever approached your clinic about allowing you to cannulate yourself?  It might be worth it if you are one of the only buttonhole clients they have.

My center gets the blunts with the plastic picks on them.  I also just started my buttonholes (around Sept 2011).  I have had to be aggressively proactive in my care because they don't have a lot of buttonhole clients.  I LOVE buttonholes.  Once established, they are virtually painless.  I'm all for that.  But I have had to request having the same tech over and over - and I've threatened to walk out and just not do dialysis when they had a tech I didn't trust.  Now, finally, they are giving me the same tech.  And she is following my request to use the "touch cannulation" method (holding the needle behind the wings and letting the buttonhole be the guide.  Today was the first day and the needles went in like I was made of soft butter.  Amazing!!!  Before, the techs were fishing and fishing and fishing - driving me crazy!  Also - i suggested that they pull the needles back out just a teense - and then I won't get that little dip where the scab can be hard to get at.  The suggestion to save picks is a good one I think.  I agree with this thread - our insurance pays a LOT of money for our treatments.  Mine is avg $4,000 a day.  You think they can throw in a plastic pick.

[Dannyboy]

OMG.  What a bunch of cheapskates....    A dual pack of blunts with 'steri-picks' can be bought retail on the internet for less than $3.00 each (U.S.) in a box of 100.    A Center buying in bulk would likely pay far less.   

So these idiots would rather spend staff $$$ time removing a scab without a pick?   I understand before my time on Dialysis it was common to use a sterile tweezers for this duty.

Care to disclose the affiliation of your Center??  (i.e. Davita or ??) 

----Dan

[amanda100wilson]

What is the cost of dealing with an inection vs. sterile picks?

[fearless]

THANK YOU ALL! for saying exactly what I was thinking: this is not best practice and increases infection risk PLUS it's NOT GOOD to "scrub" at the buttonhole site, especially when your vein is right under the surface: this could be damaging to the blood vessel!!!  Why did I allow this to happen even ONCE!?

I've had it with these cheapskates at Fresenius.  That company earned over a BILLION dollars in profit last year, but they want our flesh to suffer for a little extra money in executives' and investors' pockets.  No one should be making money off of money that's invested in someone being SICK!

Thank you all so much for the support you give.  No one in my immediate family or social circle has ever even known someone on dialysis, and they can give me love, but can never know the S--T we have to deal first hand.
I'm trying to stay grateful, and I truly truly am...but if dialysis is given to us, why can't it be given with compassion and not with a dose of "you're helpless and dependent on me, so I don't need to respect you"

and hey, PS:
I love you all

[fearless]

JeanieSpokane,

I am curious about you starting buttonholes way back in Sept. 2011, and only now using them for the first time as buttonholes?  (maybe I'm not getting this right)  I've been told it should only take a few weeks or a month.  After only 3 sessions in the same spot I'm already bleeding less when they pull the needles.
Anyway, so psyched for you that you have the needles go in so easily now!

[JeanieSpokane]

continued to Fearless.

Well, criminy - I don't know where my post went.  Wanted to say I use Fresenius too and my center has the blunts with plastic picks.  Still working on the bleeding problem.