Establishing a Buttonhole - different nurses all the time - still on SHARPS

[angieskidney]

Okay, I have had my buttonholes started Dec 8th.

It is now Jan 26th and I still have to use Sharps!

I was wondering ... is the problem being that I don't have the same nurse every single time cannulating me? Is that why they are NOT ready??


There is only so much I can do but I want my buttonholes to be established so I can just cannulate myself. It scares the hell out of me (heck I couldn't even give myself Eprex/Epogen when I was on PD) but I know with all the info on the net and the vids (Epoman where are YOUR vids! I NEEEEED to SEEEEEE them!!!) and with Epoman's posts and advice and all that, I should be able to. It just takes getting over the initial fear. Once I start doing it I know I will be okay. The fistula no longer rolls as the buttonholes are establishing .. BUT when we try to use the blunt needles .. they just PUSH the fistula all over and it acts all snakey again and does NOT cannulate


Also ..

It's ok to leave it on while they are placing both needles as long as they are quick about it and not leave it on for more that a minute or two. What about having them flush the lines with saline after BOTH lines are in? If they are flushing the lines I assume they are doing a "wet" stick?

- Epoman

I wanted to thank you Epoman. I just got back from dialysis just now. When I last posted in this thread it was right before my cab got here. So I went to dialysis. I told my nurse how I wanted the tourniquet, and she agreed with me and said she sticks both in and then takes the tourniquet off and then puts in the saline. I asked her why the other nurses usually put the saline in for each one as soon as they cannulate me? Why don't they do it like she does (the way you posted to do Epoman). She doesn't know but agreed that the way to do it is the way I was telling her to do it today.

So thank you Epoman for guiding me. I take your 13 years experience very seriously and am learning that I have the right to demand my care be a certain way.  I also told the nurse who cannulated me today exactly the angle and how I want it because since I have a different nurse all the time I realize I have to be on top of things! I can't wait til my buttonholes are finally ready for blunts so I can just cannulate myself.

[Treasure]

Hi, Angie...I'm kinda in the same boat with my buttonholes. Mine were started  on December 1st and the blunts have been very evasive. I wanted to have the nurses get the blunts going so I could begin self-cannulation... but we kept having to use the sharps. Since I didn't want to hold up transistioning back to home hemo, I steeled myself and learned to put in the sharps (I was having problems giving myself the EPo shots a year ago, too, hehehe).

I don't know if I'll ever be able to graduate to the blunts, but I'm ok with things now.  I knew I could do it...and I know you can do it too... It's getting over the fear... and I do it by just getting on with it and dealing with the fear later (magically, once I start doing something regulary, the fear is gone!)

Actually, I hate stickers on my lab report...but I sure wouldn't mind a blue ribbon for being able to stick myself, hehehe. Well, actually, I would get more enjoyment out of a tall glass of milk...ahhhhhhh!

[angieskidney]

Hi, Angie...I'm kinda in the same boat with my buttonholes. Mine were started  on December 1st and the blunts have been very evasive. I wanted to have the nurses get the blunts going so I could begin self-cannulation... but we kept having to use the sharps. Since I didn't want to hold up transistioning back to home hemo, I steeled myself and learned to put in the sharps (I was having problems giving myself the EPo shots a year ago, too, hehehe).

I don't know if I'll ever be able to graduate to the blunts, but I'm ok with things now.  I knew I could do it...and I know you can do it too... It's getting over the fear... and I do it by just getting on with it and dealing with the fear later (magically, once I start doing something regulary, the fear is gone!)

So VERY true! I am just so scared! And it is like I just wish I had someone there with me for the first time, Like Sandman or my mom or you lol! 

Actually, I hate stickers on my lab report...but I sure wouldn't mind a blue ribbon for being able to stick myself, hehehe. Well, actually, I would get more enjoyment out of a tall glass of milk...ahhhhhhh!

Oh yes what I would DO for a tall glass of milk! That had to have been the HARDEST thing in the WORLD for me to give up!!! lol 

[del]

It is really hard to establish buttonholes unless the same person is needling.  I created hubby's.  I started needling him with sharps in June when he was in center.  I did not try to establish buttonholes then.  I waited until we went for training for home hemo in Sept.  The nurse gave us a skin marker like they use for surgery to mark the way the needle went in.  After about 8 -10 treatments the buttonholes were there and we could use blunts no problem.  I usually do the needling but sometimes he does his own.  After we came home we established another buttonhole.  I have one of the markers on hand if we need to create another buttonhole.  Every now and then we still have to use a sharp to open up the hole but apparently that is normal.  Best of luck but you need the same person to needle every time to make a good buttonhole.  The marker really works.  You just have to remember to mark it again so that it doesn't wash off between treatments.

[angieskidney]

What is the marker? Can I buy it somewhere?

[jedimaster]

When I got trained, the nurse did couple of weeks the sharps, but then she showed me how to do sharps, so I would have the same angle, same hand, same push...it was VERY scary but I did it (with sharps, smaller gauge)...then we moved up to sharps larger gauge all the way to 15. After that, a week later we started with blunts. It did not work at the beginning, but after couple of weeks it did.

Now at home I use blunts 95% of the time, but somedays it just doesn't want to go in and then I use a sharp...this happens very few times and it is normal....so, patience, you both will get there!

[del]

The marker is called Secureline surgical skin marker.  The nurse that trained us for home hemo gave it to us.  It is the same marker they use when they mark where they are going to cut in surgery.  It wears off after a couple of showers so you need to keep reapplying before it wears off.  Check with the staff at your center they may be able to get it for you.  I accidentally threw the first one we had in the garbage and she had to send us out a new one.  I wanted it just in case we had to make a new buttonhole.  Hope your buttonholes get established and working it is so much easier.  Very slim chance of infiltration.  We have not had one since I started needling in June.

[angieskidney]

The marker is called Secureline surgical skin marker.  The nurse that trained us for home hemo gave it to us.  It is the same marker they use when they mark where they are going to cut in surgery.  It wears off after a couple of showers so you need to keep reapplying before it wears off.  Check with the staff at your center they may be able to get it for you.  I accidentally threw the first one we had in the garbage and she had to send us out a new one.  I wanted it just in case we had to make a new buttonhole.  Hope your buttonholes get established and working it is so much easier.  Very slim chance of infiltration.  We have not had one since I started needling in June.

True I used to get infiltrated all the time but ever since starting buttonhole I haven't had any 

[BigSky]

Okay, I have had my buttonholes started Dec 8th.

It is now Jan 26th and I still have to use Sharps!

I was wondering ... is the problem being that I don't have the same nurse every single time cannulating me? Is that why they are NOT ready??


I should be able to. It just takes getting over the initial fear. Once I start doing it I know I will be okay. The fistula no longer rolls as the buttonholes are establishing .. BUT when we try to use the blunt needles .. they just PUSH the fistula all over and it acts all snakey again and does NOT cannulate

It only takes 6-8 sessions to establish the buttonhole.

The buttonhole is probably established, however IMO it sounds like you may have used the sharps so long they have created a good amount of scar tissue on the fistula vein itself and this is why the blunts will not penetrate the fistula vein but push it away.  It very well may be you will have to use sharps on those buttonholes and establish a second set of buttonholes and move to blunts right after its established.

[angieskidney]

It only takes 6-8 sessions to establish the buttonhole.

The buttonhole is probably established, however IMO it sounds like you may have used the sharps so long they have created a good amount of scar tissue on the fistula vein itself and this is why the blunts will not penetrate the fistula vein but push it away.  It very well may be you will have to use sharps on those buttonholes and establish a second set of buttonholes and move to blunts right after its established.

Ah yes! I believe that is it! I believe you are right! I DO have a LOT of scar tissue especially at the arterial buttonhole! They took soooooo long to start buttonhole on me even though they were doing the arterial in the same spot and I had to really push to get them to start buttonhole on me (I knew my reasoning was sound). My fistula is small so there isn't a lot of spots to cannulate me. There is less scar tissue on the venous but they have only tried with the arterial and when it doesn't work with the blunt they just use sharps on both. I should see if the venous can be used with blunts today. Who knows?

[renal30yrs]

I've been using buttonhole since 12/29/06.  Make sure to let them not use toniquette when they do buttonhole!

[angieskidney]

I've been using buttonhole since 12/29/06.  Make sure to let them not use toniquette when they do buttonhole!

Why is that? When I tell them how to do things they get mad and throw facts at me like how long they've been doing this ..


by the way today I finally got both BLUNTS in!!

[jedimaster]

 

[renal30yrs]

I've been using buttonhole since 12/29/06.  Make sure to let them not use toniquette when they do buttonhole!

Why is that? When I tell them how to do things they get mad and throw facts at me like how long they've been doing this ..


by the way today I finally got both BLUNTS in!!

I certainly didn't post this offend anybody.  I apologize if I by an means ofend anybody for maing an unnecessary comment.






EDITED: Fixed quote tag error - Epoman, Owner/Admin

[angieskidney]

I've been using buttonhole since 12/29/06.  Make sure to let them not use toniquette when they do buttonhole!

Why is that? When I tell them how to do things they get mad and throw facts at me like how long they've been doing this ..

by the way today I finally got both BLUNTS in!!

I certainly didn't post this offend anybody.  I apologize if I by an means ofend anybody for maing an unnecessary comment.

You didn't offend anyone. Don't worry you did just fine! And thanks to YOU my nurse on Friday did NOT use a tournequette on me and the buttonholes worked just fine AND it is the 2nd successful time doing both blunts! 

(btw, I fixed the quote when I quoted you in this post )

[angieskidney]

Today (Monday) was the 3rd time using Blunts but I find it hard after a weekend. The arterial went in almost without any trouble but the venous gave us LOTS of trouble! IT does seem like the nurses feel that as long as they are in the holes on the skin that they should automatically be in the holes in the fistula but since they were using sharps and since the fistula rolls a LOT especially when pushed around with the blunts, it is having a very hard time. Do I have scar tissue? I really wish I coudl see through my arm. The nurses don't seem to want to listen to me. They kept saying my venous was in and I knew it wasn't. There was no flash. They kept trying to flush it when they saw no flash cuz they kept thinking it was in even though I could feel it wasn't quite right.

So frustrating!

But they eventually got it in and I ran with 2 blunts today in my buttonholes. Let's hope Wed is better. I know it is difficult but I want to know, once the buttonholes are established will it be easy? Just like when they were first trying to cannulate me with the ladder technique and kept infiltrating me but now they never do?

What other advice can you all give me on my situation?


 

[renal30yrs]

As far as my experiences go venous site seems to accumulate far more scar tissues.  In fact my venous site has been so toughend techs often have quite a hard time puncturing.

[Epoman]

Today (Monday) was the 3rd time using Blunts but I find it hard after a weekend. The arterial went in almost without any trouble but the venous gave us LOTS of trouble! IT does seem like the nurses feel that as long as they are in the holes on the skin that they should automatically be in the holes in the fistula but since they were using sharps and since the fistula rolls a LOT especially when pushed around with the blunts, it is having a very hard time. Do I have scar tissue? I really wish I coudl see through my arm. The nurses don't seem to want to listen to me. They kept saying my venous was in and I knew it wasn't. There was no flash. They kept trying to flush it when they saw no flash cuz they kept thinking it was in even though I could feel it wasn't quite right.

So frustrating!

But they eventually got it in and I ran with 2 blunts today in my buttonholes. Let's hope Wed is better. I know it is difficult but I want to know, once the buttonholes are established will it be easy? Just like when they were first trying to cannulate me with the ladder technique and kept infiltrating me but now they never do?

What other advice can you all give me on my situation?


 

With my buttonholes, the Arterial and Venous go right in smooth the first time. It's all about the angle. I haven't used a sharp since after the first few weeks. I had my buttonholes established in a week. Understand that if the ANGLE is not correct the BLUNT will NOT pierce the fistula, the blunt is not sharp enough. That is why the fistula rolls or pushes in. If you see they are trying to push and it's not going in, make sure they are trying different angles, and when you see it go in, try to remember what angle it is. Have you tried sticking one of the needles yet yourself? Once the buttonholes are established it will be easy and the needles should slide right in, but again it is all about the ANGLE. Oh also I get hardly ANY flashback with my buttonholes.

Stay with it Angie don't give up, eventually you'll be loving this technique.

- Epoman

[angieskidney]

As far as my experiences go venous site seems to accumulate far more scar tissues.  In fact my venous site has been so toughend techs often have quite a hard time puncturing.

Oh great  

What should I do about that? Is that bad or good? One of my nurses (Becky) said that of course I will have scar tissue and she rolled her eyes.

[angieskidney]

With my buttonholes, the Arterial and Venous go right in smooth the first time. It's all about the angle. I haven't used a sharp since after the first few weeks. I had my buttonholes established in a week. Understand that if the ANGLE is not correct the BLUNT will NOT pierce the fistula, the blunt is not sharp enough. That is why the fistula rolls or pushes in. If you see they are trying to push and it's not going in, make sure they are trying different angles, and when you see it go in, try to remember what angle it is. Have you tried sticking one of the needles yet yourself? Once the buttonholes are established it will be easy and the needles should slide right in, but again it is all about the ANGLE. Oh also I get hardly ANY flashback with my buttonholes.

Stay with it Angie don't give up, eventually you'll be loving this technique.

- Epoman

I will cannulate myself once it is established. Becky said it is not yet.

What you say makes perfect sense and I argued with the nurses today (had 2 standing over me taking turns trying on me  !!) and they kept pushing and I was telling them to pull out (I knew it wouldn't bleed but they thought it would as they kept thinking it was in when I could tell it was NOT!!) and retry. I mean I was frustrated they wouldn't listen to me until the 2nd nurse came and asked why the fistula was BESIDE the buttonhole!!  They finally pulled back out (and it did not bleed like I told them it wouldn't!!) and the tried again and this time got it after 7 different angles...

I paid VERY close attention on how to have my arm and the angle of the needles and other little tricks.

This is what I learned today:

• I must hold my hand like I would if I was gonna karate chop when the arterial is going in.
• I must put my palm down but not quite all the way for the venous and with my other hand pull the skin at my elbow toward my elbow so that the venous buttonhole liines up.

Does that make sense? How can I make this better? Any suggestions for Wednesday?

[renal30yrs]

It is inevitable that our skin develops a degree of scar tissues after 156 punctures a year over many years.  My fistula is so old I did almost run out of places to insert needles in.  Just like rives and streams our vessels start forming a rather tortuous curves with artificially increased flow like fistula.

[jedimaster]

Agree with EPOMAN...angle is the key. Same angle, same hand. Sometimes my blunt gives me troubles and I fix my angle and...(MUSIC) ...it goes in like butter. There is no way that different nurses will get the same angle. Do they let you do it yourself at this moment?....are you ready to bite the bullet?....once you do it, you will make sure that is the same angle, same position etc....

[angieskidney]

Agree with EPOMAN...angle is the key. Same angle, same hand. Sometimes my blunt gives me troubles and I fix my angle and...(MUSIC) ...it goes in like butter. There is no way that different nurses will get the same angle. Do they let you do it yourself at this moment?....are you ready to bite the bullet?....once you do it, you will make sure that is the same angle, same position etc....

I will do it when I know what angle and how to hold my arm. I am still learning and not confident in myself. Plus it is not established yet. How many times with blunts does it take to be considered established? I heard 8 to 12 ?

[jedimaster]

No magic number....each body reacts in different ways....I was a sloooooooow buttomholer  took me longer than that. My Dr. told me to take my time and gave instructions to the nurse to wacth it. I went home doing 1 sharp and 1 blunt....a month later I was doing two blunts....and as I said before,. sometimes I need a sharp because I can´t find the hole in the vein...the tunnel is stablished, but then the vein moves....not a biggy!

[angieskidney]

No magic number....each body reacts in different ways....I was a sloooooooow buttomholer  took me longer than that. My Dr. told me to take my time and gave instructions to the nurse to wacth it. I went home doing 1 sharp and 1 blunt....a month later I was doing two blunts....and as I said before,. sometimes I need a sharp because I can´t find the hole in the vein...the tunnel is stablished, but then the vein moves....not a biggy!

Yeah exactly EXACTLY!!!!

Well today I got the same nurse that I did last dialysis so I was happy about that (I had a choice of two but figured the smart thing was to have the same nurse right?) and she was my favourite nurse all along anyway because she was there for me in an ER incident. She listened to me where other nurses don't want you to talk because you distract them. But this nurse knew that my fistula is very difficult so she listened very closely to me. I told her the angle and the depth (I can't believe how far I have come in HD!) and held my arm at the right angle per buttonhole and pulled my skin taunt for the venous (this that are particular for mine) and it actually was a success with hardly any trouble at all for the first time ever!! 4th time in a row of blunts used but all times before there was a LOT of difficulty. I was soooo happy that today it worked so well and just because the nurse listened to me! It was so nice! But also this time we did use the tourniquet because it stablizes my fistula as it is very rolly still.