buttonholes

[billyM]

Does anyone have any experience of the buttonhole method of cannulation on HD ?

I have real problems with the venus entry point.

Its never smooth 2 days in a row , and even worse going from a saturday until a tuesday without dialysis.

What makes it worse is the blunt needles . when the channels shut , its shut . pushing a blunt needle through it aint gonna be easy .

If anyone can shed any light on this that will make things easier , i'll be grateful to hear it . 

[bevvy5]

We've been pretty lucky with Greg's buttonholes other than one goaround where, because of a few days away and then a machine issue, he went three nights without dialysis.  Then it took an hour to get the needles in, and we had some real issues after that, to the point we had to go in to the dialysis clinic, get the needles inserted, then burn home and do dialysis.  Did that two days in a row.

Greg's nurse suggested that we cannulate every day until they were sort of re-established, just flush with a couple of saline syringes just to keep the tracks open, etc.  And if we are going more than a day in between, to cannulate and flush.

I know some people use sharps if they have problems but I personally wouldn't feel comfortable doing that.  We can't even get them with our supplies.

I'm sorry I can't give a more definitive answer.

[boswife]

 are you the only one cannulating? or is there just one cannulator??  I know that having only one person cannulate can make a big difference.  In center, thats harder to get them to do though.  At least where Bo was.  Once his buttonhole was established, they started 'rotating' nurses and that wasnt good.  Each person may do a slightly different angle and that can cause problems with the sight.  Having done it for hubby now for a year and a half, i find that even slight oddities of changes can effect even the way the vein may roll.  One nurse may use tourniquit, one may not and that can slightly change where that opening to the vein is.  I was pressing and then moving my 'put pressure to pop the vein up'  hand ever so slightly and was fighting the needle till i realised what i had done.  Theres just slight things that can cause these issues, and it was his venious as well.  Exact posisition of your arm is VERY important so the nurse needs to let you be the judge of where that posisition is.  Well, im REAL tired out tonight, so hope i havent just scrambled your brain with my thoughts here   oh, and  to IHD... So glad ya found your way
 

[Desert Dancer]

Here's what I've learned about buttonholes in the two years I've been using them: there is no rhyme or reason to them. I can go for months with no problems at all - in on the first shot every time - and then suddenly I'll have issues with one of them (usually the venous). I'll go three or four days and be certain I'll have to sharp stick and have no issues, and then the next week I can't get in for love or money after only going two days. I think diet must have something to do with it too, because I've noticed when my diet is seafood-heavy they seem to close up fast.

I used to do everything in my power to avoid sharps and would go through a half-dozen blunts trying to get in. Now I don't muck about at all; if I can't get in on the first two tries, out come the sharps. I've gotten myself to the point now where I can go in just deep enough to re-open the buttonhole without touching the fistula, then I remove the sharp and insert the blunt.

As boswife said, you've also got to have your arm in the exact same position every time. If your fistula rolls, this means you may just need to move your arm by the tiniest fraction to get the door lined up with the buttonhole. Practice helps. A lot.

Bottom line? When things are going smoothly, knock on wood, be grateful and don't crow about it, even mentally.

[YLGuy]

My tech was not there today so I self cannulate.  One of them gave me such a hard time.  It usually just slides in but I could not get the right angle for a couple of tries.  When I did the second one the clamp was not closed and the little end cap had come off so when it flashed it just started pouring out.  Oooops!

[billyM]

thanks for the replies . i go into a dialysis unit , and i dont insert the needles myself . Due to the amount of nurses on duty , its never the same 2 days running . some of them are excellent , some just want the blood running .

Due to surgery on my right arm , ive no feeling in my forearm , thumb or 1st 2 fingers, so its kinda impossible for me to self canulate. mores the pity. Anyway , after reading this i will pay closer attention to angles and try to keep it the same all the time , so thanks again for the advice.

[Hazmat35]

I've had buttonholes established for about a year now.  My first set was not done 100% correctly, so they did it again. 

This time, they work great.  I have one Tech, who started them, and she does the cannulation about 95% of the time for me.  But when other Techs try to do it, they have an EXTREMELY hard time, sometimes they have to "push" so hard, it's like hitting a brick wall.  But then she comes right behind them, and the Blunt needle slides in like butter. 

it is all about the angle and the depth of the fistula.  My Tech, watched another one try to cannualte me the other day, and he could NOT get it.  She told him, he had the wrong angle, and was going way too deep.  He tried it again, and BOOM, it slid in just fine. 

I ask them if they can rotate me, so that I know who can and can not do it correctly in case she is not there.  I mean, she does deserve some time off from work, right!  So if she isn't there, someone has to be her back up! 

[PatDowns]

Does anyone have any experience of the buttonhole method of cannulation on HD ?

I have real problems with the venus entry point.

Its never smooth 2 days in a row , and even worse going from a saturday until a tuesday without dialysis.

What makes it worse is the blunt needles . when the channels shut , its shut . pushing a blunt needle through it aint gonna be easy .

If anyone can shed any light on this that will make things easier , i'll be grateful to hear it .

Learn to self-cannulate.  You'll experience less problems doing it yourself and also less pain. 

Check out these articles on Hemodoic's blog....     http://www.hemodoc.com/buttonhole-cannulation/

Bill Peckham has a self cannulation video on Youtube...http://www.youtube.com/watch?v=37W0h5Cobdk

[PatDowns]

I've had buttonholes established for about a year now.  My first set was not done 100% correctly, so they did it again. 

This time, they work great.  I have one Tech, who started them, and she does the cannulation about 95% of the time for me.  But when other Techs try to do it, they have an EXTREMELY hard time, sometimes they have to "push" so hard, it's like hitting a brick wall.  But then she comes right behind them, and the Blunt needle slides in like butter. 

it is all about the angle and the depth of the fistula.  My Tech, watched another one try to cannualte me the other day, and he could NOT get it.  She told him, he had the wrong angle, and was going way too deep.  He tried it again, and BOOM, it slid in just fine. 

I ask them if they can rotate me, so that I know who can and can not do it correctly in case she is not there.  I mean, she does deserve some time off from work, right!  So if she isn't there, someone has to be her back up!

Do you have a physical condition that prevents learning self-cannulation? 

[mcclane]

I had buttonholes, when the hospital was creating them (they would create 2, and you would alternate them between dialysis sessions).

I lost one of the holes, I could not poke myself if my life depended on it.  The 2nd one took a long while, but I eventually got it to the point where I could get the flash 99% of the time.  Throughout my home hemo, I only used one hole. 

I also found with buttonholes is that if you leave one day inbetween, they will start closing shut.  When we went to seattle in 2011, I had to switch to conventional dialysis in seattle, so there was a day's gap before I would see a dialysis machine, so I brought my own blunt needles and just needled myself in the hotel room to keep the buttonhole going.

Also, depending on how the buttonhole was created, it does take a while to get the angle just right.  Remember, it is like finding a needle in a haystack, you're trying to find 2 holes in a large vein.  The first hole you can see (the one on top), but the 2nd hole, the one in the vein, you can't see, so if you don't get the angling right you won't hit it at all.  What found helped was the tunnel in the arm.  I used that to guide the needle into the hole in the vein.

[bevvy5]

Unfortunately the OP said he has no feeling in the fingers he would need to use to cannulate.  Makes it pretty tough.

If you can try to follow your one person's work schedule so you can always get that person, it will no doubt help tremendously.  The one thing that was drilled into our heads when learning cannulation was never let anybody other than your "person", whether it's your or a helper, touch your buttonholes with a needle.

[Hazmat35]

Yes, PatDowns, I do have a Physical condition that prevents me from doing self cannulation. 

It is called SCARED TO DEATH OF NEEDLES!  There is NO WAY, 100% guaranteed that it isn't going to happen in this lifetime that I would cannulate myself.  I can't even watch when my Techs are doing it.  Not afraid of the blood, just that reched old fear of needles. 

Had it "installed" in me when I was a kid, and I've had it all these years. 

[MightyMike]

I have had buttonholes almost the entire time and I usually have more problem with my arterial.  It's best to remember to have you arm in the same position every time but due to the vein rolling this can be difficult.  Sometime I just have to push a little harder especially after the weekend.  Also self cannulation helps a lot.

[chinksnicky]

They tried buttonholes once on me I hated them ,they always hurt with those blunt needles ,I just stick myself with sharp needles in a different spot each time just like tech do and experience no pain.     Nick

[MightyMike]

That's good but I was notified that buttonholes make your fistula last longer because your using the same two holes were using the ladder technique with sharps your creating more scar tissue which eventually will cause your fistula to fail.  But nothing is ever a guarantee I guess.

[chinksnicky]

Did't know that perhaps  I should try them again.

[mamagemini]

Question (hijacking - sorry!) I know after your buttonholes are made you have easier access...my fistula is in my right arm, how can I learn to stick it myself if I'm a righty?

[MightyMike]

Yeah that's a tuff one.  I'm not too good with my left as I am right handed that's why they usually put them in the opposite arm.  The only thing I could think is maybe with enough time and patience it could be possible.  Sorry know real good answer on that one.  Good luck.

[chiawana]

My husband has what has been described as a 'great fistula' and 'beautiful buttonholes.' He was in the hospital last week (had a mild stroke) and the nurse said his vascular surgeon's work on his fistula was 'a masterpiece,' lol! So imagine my trepidation when we started doing home hemo training and I was sticking needles in those beautiful buttonholes. Intimidating much? I can relate to what everyone has said about having the arm in the same position each time, and how the vein can change overnight and be nearly impossible to stick. After one horrid episode when I almost literally jammed and shoved the venous needle to get it in, I was desperate to do something differently.  I had read on some website about touch cannulation, and watched a Youtube video demonstrating it. It seemed unbelievably easy and therefore, to my mind, almost sure to NOT work. But I tried it anyway, and lo and behold - it worked perfectly! I was so shocked and pleased. I have been doing it now for about a month and I get perfect flashback every time, and have had no issues with treatments. He generally doesn't skip more than one day (I'm a nag) without a treatment, so the buttonholes don't get too bad. He doesn't retain much fluid, so that makes a big difference.

[M3Riddler]

thanks for the replies . i go into a dialysis unit , and i dont insert the needles myself . Due to the amount of nurses on duty , its never the same 2 days running . some of them are excellent , some just want the blood running .

Due to surgery on my right arm , ive no feeling in my forearm , thumb or 1st 2 fingers, so its kinda impossible for me to self canulate. mores the pity. Anyway , after reading this i will pay closer attention to angles and try to keep it the same all the time , so thanks again for the advice.

Billly,

Buttonholes can be tricky at times... position is very important. Anything from overload of fluid to being dehydrated can affect sticking.  You may want to look up touch cannulation as well as coushion cannulation. This may or may not help.  Also, do you use a tournequet ?  This can help bring the veins closer and make them stick out and help as well.

///M3R

[Whamo]

Hazmat,  You're not the only one.  My wife says I should pay attention.  It makes sense, but I can't look.  I have to laugh at myself, an Infantry soldier, a big-wave rider, and now, a total girlie-man when it comes to needles.

[boswife]

funny Whamo     And i too am a big fobic on needles.  I still cant give insulin to hubby or even watch that or epo shots ......... but i can do his canulation and!!!!!!!!!!! we're another who uses the "touch" canulation.  Its great and wishing you all the best in what ever you end up with.  We only started home D so hubby could have the same canulator.... ME    but now wouldnt give it up for anything..

[Hazmat35]

Little by little, my "anxiety" is getting better when it comes to cannulation.  I have one Technician that I prefer over all the rest.  She is the one who started my Buttonholes, and has been treating Dialysis patients for many years.  She is an absolute ANGEL. 

When she does the initial cannulation in the afternoon, they slide in like butter.  But when anyone else in the center does it, it'l like the needle won't get past; as they call it; "a brick wall".  They have to put so much force behind it, and PUSH it through.  it is very painful, to say the least.  Figure your arm being held in a "head lock" by a 6' 2" 300 LB tech, using all his strength to push.  OUCH! 

But, what my Angel of a tech told me, after she watched them do this several times, is that they don't use the correct ANGLE to insert the blunt needle.  It is liike they are making their own "new" tracks and not following the existing.  As she explained this to one of the new techs that was having a hard time, he did it exactly as she told him, and WHAM, slid in like butter. 

It is all about the person doing it, and how much they care.  If my Angel of a tech didn't care, she wouldn't take so much time learing "me and my body" and what it takes to cannualate me.  Everyone is different.