= BUTTONHOLE TECHNIQUE - The definitive quide =

[kidney4traci]

Discuss with your nurse a few things:  why is it you have been trained on sharps for so long ( was it 5 weeks?), and have they been successful in training other pts in shorter time?  There is a training video that says this should be done in days, vs weeks.  2.  The risk it seems for the sharps every time seems to be wearing the fistula down and the increased chance of infultration.  When you are doing home dialysis you are doing it more than just three times a week, more like 5-6, and the repeated sticking will be harder on the site.  3. If you cannot use the buttonhole needles, should be using the same hole or going to a ladder technique? 

Just some thoughts I had.  Best of luck... and sorry you are havign such a hard time of it.  One more thought... maybe you should try establishing two other sites and try this again.  The holes should be established in 5 days.  Look forward to hearing how it goes, keep updating.

[del]

I have been needling hubby since June 06.  He had been on hemo for 6 years then using sharps in different sites every time.  He started training for home hemo in Sept. 06 and I was the one to establish his buttonholes.  only took about 5 or 6 treatments to get them established.  he says there is absolutely no pain for him with buttonholes.  We still have to use a sharp every now and again to open up the track.  I think the main think with buttonholes is to either self cannulate or have the same person do it all the time.  I do hubby's needles and I have never infiltrated.  Like you petey I was scared to death the first time I needled him but I didn't let him know. I had watched it done more times than I can count.  I also had a really good nurse at the unit to show me what to do the first couple of times.  I wasn't supposed to start needling until Tues ( we had to get permission for me to do it because it was a first at the unit)  but this nurse was working on Saturday. He had everything ready and I was standing there watching. He ooked at me and said you're going to put the needles in today. Will I did with hands shaking a little.  No problems since.  The couple of times he has had to go to the center I have gone with him and needled.  He has 2 for the arterial nedle and one for the venous. If we do need another venous one I am quite able to establish it. They gave us a maker like the ones they use to mark the skin for surgery to mark his arm where the sharp goes in and the angle when we have tpo establish a buttonhole.  We thing buttonholes are the way to go especially if you are on home hemo and have to do a lot of sticks.

[Jess21]

Does anyone else have the problem of the buttonhole technique not continually working?
When they started using buttonhole needles, the first day they slid right in (the nurse said it was like putting a knife in warm butter).  It worked like that for about a week, then started to get harder for them to get it in, eventually causing me to go back to sharps because the tech didn't want to mess with it too much (and this came from one of them that is specially trained to cannulate). 
Well I was on sharps for a week and went back to buttonhole, once again sliding right in.  But after a week and a half she had problems with one and couldn't get the other.  Another nurse tried it Friday, had the specially trained tech come and try, and after trying several times and my blood spraying a good 4 feet across the center (and the one time I wasn't watching!), I was put once again on sharps.
Now the tech said the first time to not worry about it cause it happens sometimes.  But twice?  I had my AV fistula created mid March, they started using it 9 weeks later.  I'm just worried that they're going to try to redirect the needle once too many and it will be "oops goes the AV Fistula".  But on a positive note before they started using buttonhole a good over a month ago they did access flow check and mine was almost 700..and 400 passes!

[overthepond]

I am a hospital based patient who has been self needling and on dialysis for around 20 years on and off.  I was given the opportunity to try this buttohole technique as a guinea pig, it is still in its infancy here in the UK.  We started with the same nurse needling with sharps for a fortnight, dont ask me why they wouldn't let me do it as I couldn't get an answer, then she went on holiday and I had a go with the blunts, after a while of trying at the first session they did eventually go in as someone said "like a hot knife through butter" but after that I could not get any access so went back to sharps in different spots - it seems the track to the vein is there it is just the puncturing of the vein itself.  when the nurse came back from her hols she tried herself again but had no luck so we used sharps down the same hole for another week.  Today was the first time of using blunts for the second time but she had to use some prodding and force to get them in and I definately felt the vein "pop", nothing like the time I got them in myself - this to me doesn't seem right as I am told they should just slide in, could it be because my fistula is over 20 years old and has much scar tissue/well developed side walls or what, I would really appreciate what others think as with it being new in my unit we are really guessing what is happening and whether or not this is normal.

Thanks

[monrein]

I've only been using blunts for 2 full weeks.  After my two day weekend break last week, on Monday I had to use sharps.  Just the one day then it was back to the blunts.  I have to push really really hard but I do  get them in.  I'm leaving shortly for D and we'll see what happens today.  I established the buttonholes myself with sharps over 4 weeks.  It doesn't hurt to shove it in the arterial but it is strenuous while the venous which was a little tricky with sharps is easy with blunts.  So weird.

[overthepond]

Thanks for the quick reply - it seems as though if patients have the odd problem with access they go in with a sharp, that was something i queried with my nurse who said that we shouldn't do that but we all know that what it says in the manual doesn't necessarilly mean its right and everyone is different

Hope the dialysis went alright without any hiccups

[Jess21]

As I said above, my arm has it's "bad days" and "good days".  People at my clinic are learning how to do buttonhole, thankfully i've been having "good days".  Only one bad day so far...they put the needle in, and pulled out more than 3 clots..felt the pop, no blood came, they thought my arm had stopped working cause they couldn't feel my thrill halfway up my arm (never have been able to anyway).  But they didn't use my buttonholes for over a week, and they slipped right in the first time they tried!  But I (and the tech/nurse) do feel the "pop" when it goes in, and my fistula started being used in July.

[monrein]

Mine both went in quite smoothly today despite the two days off over the weekend.   

[kidney4traci]

I have used the same buttonholes now for about 18 months with no problems.  Well, in the beginning I would have a day or two each month that I would have to use a sharp as the hole wouldn't budge.  But now there are no problems. 

[overthepond]

We managed to get the blunts in yesterday  but it took some doing and they still didn't go in smoothly, had that pop feeling and rebounding.  having done my needles myself for many years I just want to start doing it myself - having someone else do it is a right pain in the derriere 

[overthepond]

well we have had to give up with the buttonholeing - My fistula is over 20 years old and as such is well developed.  The process of this technique was not working for me as I was healing extreemly fast and as such had little/no scab to take off.  we also had problems with actually accessing the vein, it would take some time and pressure to get them in.  On one occasion we got a good flow from the venous on needling yet once i was hooked up my venous pressures went through the roof yet it hadnt blown or slipped out.  On rechecking the flow with a syringe we couldnt get anything, not a drop.

we have come to the conclusion that this technique needs to be used on fistulas which are quite young - I'd love to hear if anyone with a mature fistla has had success with this system and how long it took to get used to it.

least I am now on and off the machine in a decent time  and not struggling to use the blunt needles

[Chuck]

My buttonhole experience  was hit and miss. Finally quit it when I developed a blood clot in the arterial path (coincidence?)

[Bub]

My center has been using the button hole technique for several months, but I still have consideral pain while they are sticking me --- sometimes excruciating.  Can anybody suggest whats wrong.

[monrein]

My guess is that the buttonhole has been established through the path of a nerve.  My venous was painful in exactly the same way every single time but I did get used to it and since I was the only one to ever stick me I got used to the feeling.  I had an upper arm fistula and the venous was deeper than the arterial so the chances of running into a nerve may have been increased by the depth.

I think buttonholes should only be stuck by ONE person (whomever that one person might be) as consistency is extremely important with them. 

[YLGuy]

Hey Bub,
(been dying to say that)
I think Monrein is right.  When they established my buttonholes one side was fine the other hurt like the dickens.  The tech then re-established a buttonhole in a different spot than the painful one and it was better.  It still hurt but not like the first hole.  I now use EMLA cream on it and there is barely any pain at all.  GL

[Bub]

I am going to get some emla and try that.  Sticks have been too painful lately.  I have been trying to tuff it out but I guess I am a woose.

[YLGuy]

I put it on 45 minutes before dialysis and wrap my arm in Saran Wrap and tape it.

[Hanify]

I am going to get some emla and try that.  Sticks have been too painful lately.  I have been trying to tuff it out but I guess I am a woose.

I don't think it's called being a wuss when you're doing hemo and they stick needles into your arms every couple of days!!!  I'd be worried if it wasn't hurting!

[CharmedMist]

I do my husband's dialysis at home with the nexstage machine and we often do button holing.

We have a supply of both types of needles at home. Because we do dialysis 6 days a week, with button holing he can build up large scabs. So, every couple months, they have us change spots.

It's important to keep the areas clean and you should put antibiotic cream on them if they begin to scab or look red in anyway.
Button holing for us is easier, because it gives me a sense that I'm not "hurting" him as often with needles (even though we use Lidocaine and he never feels them, it's a mental think for me).  And also, it's very easy to find the fistula every time.

[billmoria]

I have been on buttonhole for 8 months. It took our nurses now time to learn how to use as it is easier (for most) than a sharp needle. For me there is no pain and my bleeding time at the end is much less. Taking the scab off never shows and blood although occasionally (on a monday after a weekend) it is a bit harder to get off but still no blood.

[kitkatz]

The nurse has started a buttonhole on my new fistula.