Moving down in needle size with buttonholes

[Simon Dog]

Does anyone here have experience moving down on needle size with buttonholes?

I've been using 15 gauge blunts for a couple of years with great success.  I am going to transition to home nocturnal (NxStage), and will be using a lower flow rate thatn can be accommodated with 16 or maybe even 17 gauge needles.  My doc an RN are concerned I will have "leakage" if I use a 16ga in a 15ga access site, and have given me the choice of starting new sites or sticking with 15ga needles.

So, has anyone here used a 16ga or 17ga in a site that was used for 15ga buttonholes?  How did it work out?

[obsidianom]

WE switched down on sharps but not buttonholes . Went from 15 to 16.   I don't see what you would gain switching down with established buttonholes. You do run a risk there . Buttonholes are so exact that any switch of angle or size is risky.  I wouldn't switch if it were me.

[Simon Dog]

Thanks.    I was not planning on switching, but would have a chat with my MD if a lot of people reported they went down in size without problems.     I'm going to stick with 15ga rather than start new sites, since my current sites have been working wonderfully.

[obsidianom]

"IF it aint broke, don't fix it"   

[Simon Dog]

"IF it aint broke, don't fix it"   

That's what my wife tells me about daytime dialysis, but I consider the high flow rate to be broke and in need of fixing.

[PrimeTimer]

I agree with Dr. O.   I would think that sticking with (no pun intended) the same buttonholes opposed to creating new ones and more scar tissue might help preserve the life of a fistula or at least leave you with more areas to stick in an emergency. Hopefully you can go at a slower flow rate when you go nocturnal using the same gauge needles you've been using. I didn't even consider that the flow rate may be affected or depend on needle gauge. Now you got me thinking...interesting...please keep up posted.

[obsidianom]

You can easily use larger needles with slower flow rates. You just cant go the other way.

[Simon Dog]

You can easily use larger needles with slower flow rates. You just cant go the other way.

My RN already mentioned that.   I'm going to add 16 gauge sharps to the tool kit so I can use a smaller gauge if the fistula acts up and I have to move to sharps.