My mom has been having frequent blood clots, but only when new techs without proper training try to poke her using the buttonhole technique. If the clot happens, the vascular team has to do a fistulagram and then a angioplasty to get the access working back again. When experience techs poke her, she never has problems with blood clots. We had fought so many times with the clinic asking not to let unexperienced techs play with her access and cause problems. Does frequent poking at the wrong place in the fistula cause blood clots? The vascular team scheduled a procedure on Monday to see what is going on. Please help. Thanks.
Lynda K. Ball, MSN, RN, CNN - along with Stuart Mott, LPN - are universally accepted as the experts on the buttonhole technique. According to Ms. Ball, the buttonhole technique does not cause accesses to clot. Clots form because staff are not using the 2-finger hold technique when removing needles (only holding one site at a time when pulling the needles). The fistula tunnel then has a complete clot that forms and is very hard to remove.
She also believes best demonstrated practice technique to establish buttonholes requires the same cannulator for the creation process. That person must show the angle of insertion to others who are going to be inserting a patients needles. Consistency among the staff is key.
This is an easy to understand and pretty thorough presentation by Ms. Ball on trouble shooting buttonholes -
http://www.therenalnetwork.org/qi/resources/ButtonholeTroubleshootingComplications1.2013%20.pdfThis link provides good info as well -
http://homedialysis.org/documents/pros/ButtonholeCannulation.pdf I hope this helps. - SutureSelf
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