Barriers to home dialysis

[monrein]

You know Del it's funny about the transplant option because although I had a super fantastically successful first one for a very long time, I'm a bit nervous about another.  I'll do it for sure if I have a chance but am well aware that there's no guarantee it'll be a walk in the park.  I also liked my forearm fistula better than the upper arm one I have now but know others who have had exactly the opposite experience.  I love how well home nocturnal works for you guys and I really admire your husband and all his projects.   

[del]

Hubby has an av fistula that goes from his wrist up his arm like a piece of garden hose!!!  been working perfectly for 8 years.

[flip]

mine looks like the sprinkler version now

[del]

  flip you are sooo funny.  So did hubby's!!!  He has been doing buttonholes for the past 2 years so now only 2 sprinkler holes!!!

[lola]

Otto starts training on Monday for Home-Hemo and when I asked about me needing to be there everyday they said I can come as much or little. Otto also can do it at home alone they just want to know if that's what he is doing so the Dr can know. I plan to go as much as I can but with 3 little ones at home I don't think I will be there as much as I would like to be, although I think it will be good for Otto to learn how to do this himself since I always tell him he's in big trouble if I ever get hit by a bus

[flip]

del...I've often considered buttonholes. Give me your honest opinion.

[del]

In hubby's words "butonholes are the best thing I have ever done"  He says once they are established they are completely painless. You don't pierce the skin anymore. I do the needling.  Just clean the site get the scab off with tweezers , clean the site again and the needle almost falls in the hole. Once it is established the track is very easy to follow because the needle won't go anywhere else.  It's not sharp enough to puncture.  There are times especially after a night off when the needle will go in the track fine but when it gets to the vein I have to give it an extra nudge to get it through. If a buttonhole stops working for some reason you just establish a new one. Sometimes (very rarely) we have to use a sharp in the buttonhole just to open it up again.  Haven't had to do that now for months.  I have never infiltrated him with the blunt buttonhole needles. Take about 2 weeks using a sharp everytime to get the track established.  If you keep the sites clean when you are needling very little chance of infection. I was told never to take the needle out and reinsert it.  If I had to take it out use a new needle.  He sleeps with the 2 blunt needles in his arm and has never had any problems with it.

[flip]

Baxter has a kit that includes a needle and a plug for establishing new buttonholes. Just a couple of questions:

How hard is it to stop the bleeding?
Can you go swimming without danger of infection?
Does it shorten the life of the fistula?

[del]

Actually flip according to everything I have been told and read it is supposed to be easier on the fistula.  Hubby does not bleed a lot never has - in about 5 -10 minutes he is ready to tape. He just folds a 2x2 puts it over the hole holds it for 5 to 10 mins and tapes it over with one inch tape.  He hasn't had any problems with bleeding.  Don't know about swimming but hubby does everything with his arm (it gets awfully dirty sometimes!!!) .  Have to check with a doc or nurse about the swimming.  I don't know anything about a plug for establishing buttonholes.  We just use sharp needles. We have a marker like they use in surgery for marking the skin to show the angle the needle goes in at.

[Adam_W]

I'm pretty sure it's ok to swim with a fistula, with or without buttonholes. Like del said though, I'd ask your doc to make sure.

Adam

[flip]

I swim in the lakes with my fistula but someone told me there was an extra danger of infection with buttonholes. I'm just exploring my options. I don't think I would want to sleep with needles in nor would I want to do nocturnal dialysis for the same reason.

[monrein]

I'm establishing my buttonholes now and when I asked about the biohole plug I was told by the nurses that they've found they can lead to infection so they don't like to use them here.  I'm getting my arterial in pretty easily each time now but my venous is more tricky because it's much deeper.  I keep trying however and the holes are getting bigger and easier.  No problems with bleeding, exactly as Del described.  I soak the scabs with swabs, then pull the skin taut one way then the opposite way to try to loosen the scabs a bit, then I use a new needle (same as the one I use on my heparin bottle) to remove the scabs.  If I were worried about infection from swimming (I've never been told it's a problem but I'll ask)  I think I'd get some tegaderm bandages to put over the buttonholes.  You could cut fairly small pieces from a larger bandage.
My understanding also is that buttonholes prolong the life of the fistula and also they reduce the likelihood of aneurysms and bulges in the fistula. 

I'm very pleased so far with how they're coming along and glad I decided to establish them immediately upon starting to use my fistula.  I'm going to get a marker as Del suggested to help me with the venous because it's at a funny angle in addition to being deep.

[flip]

My arterial is the toughest because I have a nerve that runs down it. If you miss the stick a fraction of an inch, it's very painful.

[G-Ma]

As for one handed sticking, I used the same arm clamp to hold my graft in place, so I didn't have to worry about trying to hold the bloody thing down as I was putting the needle in. Both of those techniques worked really well for me.
Adam

Thanks Adam.  I'm going to try this as my veinous area rolls.
Ann

[del]

We were also told that buttonholes were supposed to prolong the life of the fistula.  We were told when we trained to use a needle like monrein does to remove the loosen the scab and then use sterile tweezers to remove the scab. A few months ago we were told not to use the needle any more to loosen the scab (could cause infection)  We were supposed to just use the tweezers to get the scab off. Well we are back to using the needle to loosen the scab just didn't work well with just the tweezers.  Haven't told his dialysis nurse that we are using the needle lol. What she doesn't know...   For a year and a half we were using the needles and no nfection.  Seems they were getting some infections in the buttonholes in center.  Different at home - not as many germs!!! I hope not anyway!!  By the way what is a biohole plug???

[flip]

It's a kit made by Baxter for developing buttonholes. It has a needle and a plug. The way I understand it, you insert the plug after removing the needle. I've seen them on Baxter's website but don't know anyone who has tried them. The kit runs about $85.

[monrein]

I use a sterile needle (the same kind I use for the heparin bottle) on a cleaned arm.  First thing is to use the fingers to stretch the skin over the scab area one way then the other (fingers on each side then pull gently) then use sterile gauze with liquid anti-septic to soak a little, then gently pick off scab.  If they were getting infections, something careless must have been happening somewhere.  

Unfortunately, I've gone back to laddering with sharps for a while to develop my fistula evenly up the arm a ways.  Once it's bigger and stronger I'll establish the buttonholes which shouldn't take too much time with daily runs.  I sometimes do my arterial cuz it's easy but the venous is deep, tricky and rolls so I let the nurses do it.  I insist however that they proceed a little higher each and every time so that the vein develops as evenly as possible.  They sometimes want to go where it's "easiest" but I don't let them.  I was very strict about this with my first fistula and had no aneurysms or lumpy bits so we'll see what happens.  The vein is strengthening nicely and I'm running now always at 400 pump speed with 15 g needles.  

[del]

That's the same as we use monrein sterile needles on a cleaned arm.  I agree someone is being careless if they are getting infections.  Never heard of bioplugs. We deveoped the buttonholes just using regular 15 g sharps.  Hubby's fistula developed to well above the elbow.  has lots of room for needling!!  He always told the nurse where he wanted the needle put when he was in center.

[Hemodoc]

Monrein, it sounds like you are doing well with a good strategy.  The most important aspect is to establish control over your own arm.  If they ruin your access, they will think it was going to happen anyway which is not true.

As far as the buttonhole button, I believe that is potentially a great way to get a serious infection quickly.  I am now on treatment 5 of a new buttonhole and it is almost completed.  I have done the new stick all by myself when I noticed some enlargement at the other site.  The body forms scar tissue quite quickly.  I really see no reason why anyone would take the risk of infection with an indwelling device.  Not needed at all.  Just my opinion.

[bette1]

I was offered home hemo, and I could do it, I have done pd before, but I refused it.  I did not want to have to worry about dialysis 7 days a week.  I like being able to think of dialysis as my part time job.  I can get may treatment and then be 'off'" for a while.  I have a young child at home and I didn't want my illness to take over our home, and that is what happens with home dialysis. 

I think home hemo is a great option, but it is not for everyone.  I do think that not enough patients are educated about the option

[plugger]

Just thought I would stop by and say hello.  Thought I would mention it is a good time to get involved with the elections and make some of our politicians aware of what is happening in this field of medicine.  I'm trying to do what I can to make sure my state reps stay in office - they were great in getting a bill for certification of dialysis techs through!  Hope I will be able to revisit how they might help with home dialysis after the election.

[kitkatz]

I asked my hubby if he could stick me and he does not now if he can.   He is also not comfortable with the idea of having me on home dialysis if he is gone. He wants to travel one month a year. I can train my sister to help me if I need to on an emergency basis. I do not know if I can have him stick me.

[Wallyz]

I have been talking to people who are good candidates for Home hemo in my center. And one guy was complaining about having to stick himself. I said- "Are you still able to have sex with your wife?" He said no, and I told him that his chances of regaining his ability to maintain erection would go up dramatically if he did home hemo, especially extended therapy.  When faced with that trade off he was encouraged to get over his fear of self cannulation.

[petey]

I have been talking to people who are good candidates for Home hemo in my center. And one guy was complaining about having to stick himself. I said- "Are you still able to have sex with your wife?" He said no, and I told him that his chances of regaining his ability to maintain erection would go up dramatically if he did home hemo, especially extended therapy. When faced with that trade off he was encouraged to get over his fear of self cannulation.

Home hemo doesn't always mean self-cannulation.  If you have a partner, and if your partner can -- and will -- learn the technique, the partner can cannulate.  That's what Marvin and I do.  He's the patient (and can and does do every other thing required for home hemo), while I am the "sticker."  (I also can do all of the other things required for his home hemo treatments, but he wants to do everything else -- machine set-up, ordering supplies, care and maintenance on his machine, etc. -- by himself.)  Marvin doesn't look while he's being cannulated -- he didn't when he was in-center (almost 14 years) and he doesn't look now.

[Wallyz]

I agree- but he felt that his wife cannulating him wasn't an option either.  Sorry I wasn't clear.