Cannulation Technique

[obsidianom]

Since I posted the article on Buttonhole vs. Rope Ladder Rotating site cannulation, I have been thinking a lot about both. I dont have the experience of lots of patients , just my own with my wife. I would like to learn more from other patients.
SO------I would like to hear from all of you out there who self cannulate fistulas either at home or in-center. What technique do you use, and why? What has been your experience both good and bad with the technique you use.  Include any fistula issues and infections.  How long have you been doing it this way.  What size needles do you use both guage and length.  Anything you can add is helpful.  Any unique experiences you have had would be good to add.    We can all learn from this.
I am coming into this with an open mind.  I see both techniques having pros and cons.

[cassandra]

Well, Obsi they do have the good, and the bad. I've done 10 yrs ladder (in-centre) and in my 2' yr BH. I only switched to BH because of doing daily HD.
I was always convinced the BH were no-good for old fistula's, but they are. The aneurysm shave 'disappeared. I thought I had my first infection last week, and spent a 'day' in hospital for tests, but false alarm, so I'm still happy with BH.

Pros: less pain cannulating.
         Not much chance infiltrating
         Can move my arms during treatment

Cons: more time cleaning, and scabbing.
           More scared of having an infection

I use 15 gauge, 1,8mm

I use anti-bac silver plasters after the 'blood spurting out' has stopped after a session.

All the best, Cas

[amanda100wilson]

Have been doing NxStage for two years and have used buttonholes the whole time.  Use short needles as I don't have a lot of straight length or length in general, which is also reason for doing BH technique, but other reasons are less chance of infiltrating and less painful.  I also wanted to use them because I understood that hey are better on preservation of fistula.  I don't find Stuart's facial scrub works.  I use anti-bacterial soap on fistula, and then prior to cannulation use a damp gauze held on by Tegaderm.  at time of cannulation, I access with ExCept, pick using picks supplied with needles, but also wipe over pointy tweezers and remove those pieces of dead skin around fistula, making sure that I don't use them at BH entrance.  then I clean again with Except, put in arterial needle, clean venous site again with Except and cannulate venous.  No infections to date.

[cameron fields]

obsidianom, My Dad has been doing dialysis for more than 14 years. He uses the buttonhole technique. Research has shown that when using the buttonhole technique there are fewer cases of swelling from the dialysis needle going through the fistula wall (infiltrations), reduced misses when attempting to place needles, and less pain when the needles are inserted.

Recent findings have also indicated that there is an increased risk of infection with buttonholing. Although my Dad hardly ever gets infections make sure that you swab before and after removing your scab, and if you need to fully withdraw the needle while you are "hunting" for the flap, start again with a new needle.

Wishing you the best!,
Cameron

[Simon Dog]

Button hole here, but I've only used them about 60 times so far.

I take 2 pieces of folded 2x2 on each and then squirt 5ml of saline on each when I start setup, which results in soft scabs by picking time My protocol is alcohol wipe each, do a second alcohol wipe and pick scab, then a third alcohol wipe just before canulation, using a total of 6 wipes in the process.   My clinic (Fresenius) taught me to saline flush each line before hookup, however, I noticed that was not the process at a DaVita clinic I visited - though they let me use my own procedure.

I use a dab of Bactriban cream on the gauze used to bandage the holes.   I originally tried using a betadine patch under the gauze, however, that irritated my skin after a few weeks - no such problem with the Bactriban.

[Rerun]

Don't some of you Canadians use "single-Needle"... a 12gu.  One needle not two?  The K machines have a setting for single needle. 

     

[amanda100wilson]

 I was taught saline swab and betadine swab.  Can't see the whole properly with latter on so use Except.

[Simon Dog]

Don't some of you Canadians use "single-Needle"... a 12gu.  One needle not two?  The K machines have a setting for single needle. 

     

I assume (yes, I know assume parses ass/u/me) you are talking about the Fresenius 200K/200K2/BabyK.    Single needle dialysis requires a different configuration on these machines, the most notable aspect of which is two blood pumps.  Single needle is not that popular in the US since it is less effective per unit time, as you are only taking or returning blood at any particular point in time.