Sharps in button holes?!

[Angiepkd]

I am in the process of making new button holes after having a surgery to reduce the flow in my fistula. My old button holes were working great, but there were a few times when I couldn't get the blunt needles in and used a sharp. My nurse specifically told me to never use a sharp in my button hole, and to stick somewhere else if I couldn't get my blunts in.  From what I have read on IHD, lots of you have to use sharps occasionally to reopen the button hole.  My husband gives me quite a bit of grief when I have to do this, even though I am very careful to follow the same track.  What is everyone's opinion on this practice?  Am I damaging my fistula by using a sharp once in a while when the blunts won't cooperate?  Do any of you always get the blunts in without any trouble?  Any help or advice would be greatly appreciated!

[Angiepkd]

I noticed this is pretty much the same question I asked previously. Sorry!  Just needing a little more reinforcement.  Hubby has me second guessing myself.  Just my luck this was the topic during one of the three training days he attended lol!  I know he is only trying to protect my fistula and my life, and I appreciate his help, but I just need him to back off a little.  I realize this makes me sound like a jerk, when so many people deal with the exact opposite behavior from their partners.  Just needed to vent I guess!  Now back to that button hole question.......?

[KatieV]

With all my needle issues lately, I'm supposed to use a sharp in the buttonhole if I can't get a blunt in.  They said to take the sharp immediately out and stick a blunt in.

I used a sharp on Wednesday in my venous buttonhole, but hadn't been told the above yet.  Despite keeping my arm still, the needle ended up moving and infiltrated while in treatment.  My arm JUST finished healing from the last time it was purple!  It was a real downer to the excitement of me putting in my own artieral needle.  It was my first time doing it - it slid in like a dream!     

[Angiepkd]

Thanks Katie!  Sorry you had trouble with the sharp. How do you get the sharp out and the blunt in without bleeding all over the place?  I had really good luck with my original button holes, but this stupid surgery has me back to square one.  I love doing NxStage at home, but these darn needle problems have me pulling my hair out.  I had to miss treatment on Wednesday because of a clogged arterial needle that I couldn't fix.  Luckily, my nurse was available yesterday and she let me dialyze there.  She also helped me pick out sites for the new button holes.  Tonights treatment went great using sharps.  Here's hoping we can get those blunts in without more issues!  Hope your arm heals quickly and thanks for answering my question!  I know we can get through it!

[lmunchkin]

Sorry you guys are having these problems.  Make me realize how fortunate we are with his fistula.  We do the ladder method using 15g needles, and its so much easier for me & now Im like, easy peesy!  I know if I had to do bottonholes, I would goof up for sure!  Im like all over the map with them sharps, so I know I would not be good with blunts.

Plus, He has a very thick rope.  He is nothing to stick at all.  At first, I was unsure, but now, I know when Im in!  Isnt it amazing how much we have learned?  I look back on it and am so amazed at the progress we have all made.  Think of the Mountain we attempted to climb.  Remember how Overwhelmed with learning it, and I almost quit, I want you to know. The thing is, none of us are quitters, and our persistence won out!!  Amen?

Well, I hope you guys get it straightend out.  I know you will, so I don't worry at all about that!

God Bless,
lmunchkin

[Angiepkd]

Thanks Imunchkin!  You are an inspiration to us all!  I am sure I will become as confident as you are. Just gonna take some time and practice.   

[JohnJ]

I can't use fistula needles..they just don't work. I've been using sharps EVERY day for 3 1/2 years now with no problems. I've changed sites twice but that was due to other problems. My vascular surgeon (who was also on a kidney transplant team (and heart and liver) told me using sharps every day is fine. I know some nurses and nephrologists will tell you differently however I think I'll take the advise of a vascular surgeon and keep on using sharps.

[dieterschien]

Please, let me get this clear, you have been using sharp in a buttonhole by your self ...

[Desert Dancer]

Thanks Katie!  Sorry you had trouble with the sharp. How do you get the sharp out and the blunt in without bleeding all over the place?  I had really good luck with my original button holes, but this stupid surgery has me back to square one.  I love doing NxStage at home, but these darn needle problems have me pulling my hair out.  I had to miss treatment on Wednesday because of a clogged arterial needle that I couldn't fix.  Luckily, my nurse was available yesterday and she let me dialyze there.  She also helped me pick out sites for the new button holes.  Tonights treatment went great using sharps.  Here's hoping we can get those blunts in without more issues!  Hope your arm heals quickly and thanks for answering my question!  I know we can get through it!

Hi, Angie - I have occasionally needed to reopen a buttonhole with a sharp but there's no way I can leave in a sharp while I sleep, so I always pull the sharp and insert a blunt.

If you're doing this alone, you really can't make the switch without getting blood everywhere. I just have a gauze pad folded up and ready to go as soon as the sharp has cleared my skin, but no matter how quick you are about it you'll still have a little. I think it looks like a lot more than it actually is. With a partner, of course, they can just be johnny-on-the-spot with the gauze and there are no worries. Just be very, very sure not to press down on the gauze until the sharp is out.

I always detest having to do this, though; paranoid I'll get my angle wrong and screw up my buttonhole. It's never happened, though. My nurse told me it's not the greatest idea to use sharps in the buttonholes because of the chance you'll get the angle wrong and tear up the track, though obviously it's working well for JohnJ.

[JohnJ]

Yes, I use sharps ON MY SELF every time.
You go for arteriogram, right? You go see the same doctor that did your access? Ask him\her. THEY are the experts on your fistula and they can give you the best answer.

[Desert Dancer]

You go see the same doctor that did your access? Ask him\her. THEY are the experts on your fistula and they can give you the best answer.

Sound advice. My surgeon is proud of his work and calls it 'his' fistula, which it is really. Any good surgeon would feel the same way about their craftsmanship and would not advise you to do anything that could damage it.

[Angiepkd]

Thank you all for responding!  I have made the new button holes, but still can't seem to get the blunts in yet.  I am going to give it a few more tries and start over.  The worst part is I had the old button holes working most of the time.  The flow reduction surgery I had ruined them, and the new ones aren't cooperating.  I am hoping to get the blunts in tomorrow.  I have been cleared by my surgeon to use a tourniquet again, and that really helped with my arterial.  Thanks for the help!  Tomorrow is another day!

[Hazmat35]

I've been doing in center hemo for 4 years.  I have had 3 sets of button holes now.  Just started the 3rd set this week.  It always seems that after the button hole is "established" and is working fine, that it develops a callus or hard surface and they have to use a sharp for a couple of days...then it's back to blunts....then back to sharps...off and on over and over. 

My nurse / doctor said that my immune system is working overtime to heal itself, which is a good thing. 

[lmunchkin]

Hey Angie!  Any updates on how its going?

lmunchkin

[Angiepkd]

Hey Angie!  Any updates on how its going?

lmunchkin

I had to have another fistula revision because they clotted my fistula somehow during my surgery last month.  Back to sharps for now.  I am afraid to try the blunts again as I have had no luck with them since the first set failed.  Kind of depressing!  Thanks for checking in!  Maybe next week I will get up the nerve to try again!

[noahvale]

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[Angiepkd]

I do use the touch cannulation method, or at least my best attempt at it.  I keep chalking it up to being such a fast healer, but that is probably an excuse.  Next week I will give it another go!

[obsidianom]

I have been using Touch cannulation on m wife at home for 4 months. I was never shown how to hold the needle by a nurse so I instinctively started holding it the Touch method way behind the wings and it worked perfectly for the first 4 months. I never had a single issue until a small infection started this week. When I go back to the fistula I plan to start again on buttonholes. Should I use the same tracts with sharps at first or try new tracts? I have never had to restart so far so this is new. We are on a catheter for about 2 weeks then back to fistula.
The idiot doctor started to try to stop me from using buttonholes due to this minor infection. He wants to go back to rotating sites. However my wife's fistula is short and has no room to really move around. I have only about 2 and a half inches of good length to work with. that is why buttonholes worked so well. I just put the holes 2 inches apart at the ends of the enlarged area.

[PatDowns]

I have been using Touch cannulation on m wife at home for 4 months. I was never shown how to hold the needle by a nurse so I instinctively started holding it the Touch method way behind the wings and it worked perfectly for the first 4 months. I never had a single issue until a small infection started this week. When I go back to the fistula I plan to start again on buttonholes. Should I use the same tracts with sharps at first or try new tracts? I have never had to restart so far so this is new. We are on a catheter for about 2 weeks then back to fistula.
The idiot doctor started to try to stop me from using buttonholes due to this minor infection. He wants to go back to rotating sites. However my wife's fistula is short and has no room to really move around. I have only about 2 and a half inches of good length to work with. that is why buttonholes worked so well. I just put the holes 2 inches apart at the ends of the enlarged area.

Home Dialysis Central is probably the best resource site for questions about AV accesses and buttonhole technique:  http://forums.homedialysis.org/forums/20-Stuart-Mott-Cannulation-Expert

You can also register and then pose questions if not finding answers you're needing.