tourniquet - to use or not to use

[angieskidney]

Question: When doing buttonhole, is it better to use a tourniquet or not use one

and WHY?

[BigSky]

With a buttonhole you shouldn't need a tourniquet nor would I think its wise to use one in that situation IMO.

Being that the buttonhole is merely a formed tunnel and the blunt is to slide into it in the same manner as a earing being put into a ear with the exception that the blunt punctures the vein at the end.  Putting a tourniquet on it causes the vein to swell which in turn can distort the buttonhole tunnel thus keeping the blunt from going in at all or if using a sharp in a buttonhole cause it to deviate from the formed tunnel itself.

[angieskidney]

With a buttonhole you shouldn't need a tourniquet nor would I think its wise to use one in that situation IMO.

Being that the buttonhole is merely a formed tunnel and the blunt is to slide into it in the same manner as a earing being put into a ear with the exception that the blunt punctures the vein at the end.  Putting a tourniquet on it causes the vein to swell which in turn can distort the buttonhole tunnel thus keeping the blunt from going in at all or if using a sharp in a buttonhole cause it to deviate from the formed tunnel itself.

Man ... someone just called me last night to say to use the tourniquet so that my fistula does NOT roll as much as it has been. That using one will keep it more stable.

I keep hearing so many different things that I really don't know what to do .. including different things from my own nurses.

Do you guys think I should call up my surgeon who made the fistula and ask him??

[BigSky]

Well my understanding is the buttonhole itself is a formed tunnel.  If the blunt is inserted into this tunnel and goes in, the buttonhole is formed.  It is at the end of this tunnel that the blunt actually punctures into the vein of the fistula. 

If the blunt is indeed going into the buttonhole tunnel but and it is pushing the vein away at the end then IMO it sounds like you have developed some scar tissue on the vein itself thus making it harder for the blunt to puncture the vein and thus pushing it away.

What you can try is to put the blunt in up to the point it starts to push the vein away.  At that point have the nurse put slight tension on the skin above the insertion point and this should keep the vein from trying to move. 

I have used this technique  before when at times the sharps didn't want to puncture the vein but tried to push it away some.

[angieskidney]

Well my understanding is the buttonhole itself is a formed tunnel.  If the blunt is inserted into this tunnel and goes in, the buttonhole is formed.  It is at the end of this tunnel that the blunt actually punctures into the vein of the fistula. 

If the blunt is indeed going into the buttonhole tunnel but and it is pushing the vein away at the end then IMO it sounds like you have developed some scar tissue on the vein itself thus making it harder for the blunt to puncture the vein and thus pushing it away.

What you can try is to put the blunt in up to the point it starts to push the vein away.  At that point have the nurse put slight tension on the skin above the insertion point and this should keep the vein from trying to move. 

I have used this technique  before when at times the sharps didn't want to puncture the vein but tried to push it away some.

Thanks for that! I will print out your advice and bring it with me to dialysis! Thanks!  

[renal30yrs]

You don't want any needless pressure on your fistula arm.  Not I'm bragging but speaking from 27 year experience with the same fistula.

[Epoman]

Question: When doing buttonhole, is it better to use a tourniquet or not use one

and WHY?

I use the buttonhole method and I do not use a tourniquet, however my fistula is 13 years old and it is nice and big. If you use a tourniquet to make the cannulation easier, be sure to remove it right away do not leave it on for more then a minute. It shouldn't take that long to cannulate a BH, I do both of mine in under 20 seconds.

- Epoman

[Epoman]

You don't want any needless pressure on your fistula arm.  Not I'm bragging but speaking from 27 year experience with the same fistula.

  You are very forunate. I hope I am that fortunate. That is amazing. I have had mine for 13 years.

- Epoman

[renal30yrs]

 :2thumbsup;Thank you Epoman.  There's no trick or secret.  Avoid any pressure or concussion your fistula arm if you can.  I remember the folks with external shunt always being so careful.  Must have left such an impression on me.

[Panda_9]

It depends on how developed your fistula is. If its only new you will need a torniquet. I have just stopped using one as my fistula is now developed and firm. Try cannulating without a torniquet and see how you go. You need a nice firm area to cannulate ideally. If it is to prevent your fistula moving then I would use it. Just tighten it firmly, enough to keep it stable, dont strangle your arm with it.

[angieskidney]

It depends on how developed your fistula is. If its only new you will need a torniquet. I have just stopped using one as my fistula is now developed and firm. Try cannulating without a torniquet and see how you go. You need a nice firm area to cannulate ideally. If it is to prevent your fistula moving then I would use it. Just tighten it firmly, enough to keep it stable, dont strangle your arm with it.

The nurse still cannulates me til it is established. What if I put my finger down on my fistula to act as a tourniquet but not as tight. That way I can keep it stable as well. Does that sound feesable or like a dumb idea?

My worry is that every time I am cannulated, that even though they cannulate me in the same buttonhole, that it is not yet established so if my arm is not exactly in the same position each time that they are not actually cannulating in the same spot on the fistula, just on the surface. Does that make sense?

[renal30yrs]

No matter the beauty of using blunt needles is you never need to worry about infiltration or other types of nasty damages from sharp needles.  What pushed me to do buttonhole was when the tech accidentally punctured all the way trhough the vessel wall and to the outer skin a few months ago.  It was not a pretty sight to see blood spurting needle sticking out of your other other side.

[angieskidney]

Doesn't help when the nurses don't exactly make me feel confident in their skill when the one nurse said to me, "those aren't buttonhole needles" (the green clamp lines). I told her they are and that the regulars have white clamps. She said, "Oh the buttonhole lines used to haev red clamps.."

Made me wonder how long it has been for her 

[tamara]

No matter the beauty of using blunt needles is you never need to worry about infiltration or other types of nasty damages from sharp needles.  What pushed me to do buttonhole was when the tech accidentally punctured all the way trhough the vessel wall and to the outer skin a few months ago.  It was not a pretty sight to see blood spurting needle sticking out of your other other side.

My venous is really high to the surface, and can feel the needle sharp from the outer of my skin, just waiting for the day when I do this.     

[renal30yrs]

Absolutely insist on doing all the taping on your own or be very vigilant about what they do.  When did nasty "mishap" happend the second time it was because the tech was not paying attention and ended up pushing the needle (venous) with the taping hand.  Stay vigil and stay safe.

[tamara]

I'm in safe hands ( I hope) cause I do all my treatment, if I can't be careful on my self then i have problems !

[renal30yrs]

Ideally that's best way to go.  Less manhandled by strangers your fistula is likely to survive longer.

[tamara]

Ideally that's best way to go. Less manhandled by strangers your fistula is likely to survive longer.

I agree, when you do it yourself, you can also feel when it is in properly ( or i can anyway can't speak for everybody)

[Amanda From OZ]

You don't want any needless pressure on your fistula arm.  Not I'm bragging but speaking from 27 year experience with the same fistula.

Slightly off topic ... but what about pressure placed on the fistula due to doign weight training? how bad is that for your fistula?

Thanks Amanda

[renal30yrs]

Avoid any needless pressure on fistula if you can help it.  You might want to consider doing workout that would  not involve the use of your fistula arm.  Under our circumstances good fistula is the only thing we have.

[angieskidney]

Avoid any needless pressure on fistula if you can help it.  You might want to consider doing workout that would  not involve the use of your fistula arm.  Under our circumstances good fistula is the only thing we have.

Yet working out to encourage blood flow to the fistula is a good thing .. like lifting weights (light ones) and doing bicept curls with cans or weights or squeezing a small stress ball! 

[Amanda From OZ]

Yeah good point.

I think i might just stick to light werights. Thanks.

[AlasdairUK]

I would do light weights on your fistula arm and try to keep your arm below your head.

[Amanda From OZ]

thanks.

Also at my training center they always recommended a tourniquet for me, because my fistula is small. I couldn't imagine doing it without it. But i do remove it as soon as i get my needles in.

[angieskidney]

thanks.

Also at my training center they always recommended a tourniquet for me, because my fistula is small. I couldn't imagine doing it without it. But i do remove it as soon as i get my needles in.

Ya some nurses would flush my lines (you know how they do that after they cannulate you) .. but would flush each line right after cannulation and wouldn't take off the tourniquet between flushings

So I would just take it off myself (they are too busy to prevent me).