Stopping Button Holes????

[Hazmat35]

I just found out yesterday; that they are STOPPING the use of Button Holes at my center.  They said that it is because there are too many people getting infections because some of the PCT's at other units / clinics are getting infections because they don't clean the Access well enough; or they push the scab in and don't scrape it off. 

I've been doing BH for over 5 years now; and haven't had one issue.  Has anyone else come across this?  I am really upset about it!

[kitkatz]

As they transition, often they will leave established buttonholes alone for patients who have not had problems with infection in their sites.  Talk to your FA and nurse about it.

[iolaire]

Maybe use this change as an opportunity to move to cannulating yourself?  At various centers I'm told that self cannulation is best but I've never made the jump.  Luckily I've only had problems with them missing my huge fistula once or twice.

Also I should note that my center doesn't use buttonholes and someone transferred in with them.  They used them for a bit and had a lot of problems with them (I'm sure because they are used to sharps) and forced him to move away from buttonholes.  Also in Belgium they claimed the huge fistula I have is because I'm not using buttonholes.

[Cowdog]

Hi HazMat
Same at my center unless you self cannulate. Decision was made based on reported infection rates at other clinics. Discussed this in depth with my Neph. He admitted that he suspected the infection rates were more related to personal hygiene of the affected patients.
But I wouldn't recommend buttonholes for anyone being cannulated by PCT. They have no way of feeling the track and will force through any resistance instead of pulling back and finding the path. Have seen it happen!!
If you self cannulate they can't stop you from using buttonholes.

[Cowdog]

Hazmat, who's your provider? I'm with Fresenius.

[Simon Dog]

Also in Belgium they claimed the huge fistula I have is because I'm not using buttonholes.

There is some evidence to suggest that pseudo aneurysms are more prevalent with laddered sharps that button holes.

[Hazmat35]

As they transition, often they will leave established buttonholes alone for patients who have not had problems with infection in their sites.  Talk to your FA and nurse about it.

I did; and he said that it is a COMPANY decision; and he is NOT ordering any blunt needles for anyone.  Our clinic actually has the most patients per clinic in our area.   

[Hazmat35]

Hazmat, who's your provider? I'm with Fresenius.

DaVita

[Hazmat35]

Hazmat, who's your provider? I'm with Fresenius.

DaVita

[cassandra]

Dear Hazmat write to whoever is in charge of your care. I remember reading (I'm not in US) that when your Dr prescribes, even Davita has to fulfil that prescription. And seriously start to learn to cannulate yourself.

Good luck, love and strength, Cas

[Simon Dog]

Dear Hazmat write to whoever is in charge of your care. I remember reading (I'm not in US) that when your Dr prescribes, even Davita has to fulfil that prescription. And seriously start to learn to cannulate yourself.

A problem is that nephs are often under contract to the dialysis facility and will only prescribe within corporate policy.

My neph is great, but he will not prescribe a 200 or 250 filter unless the Fresenius P&T committee approves the extra expense - which requires that the patient not "make goal" at 4.5 hours of chair time.   Fresenius will not allow someone who meets goal with 4.5 hours to get a 200 filter instead of a 180 - after all, the patient's time is cheaper than the bigger filter.  (they grandfathered patients on the larger filters before this cost saving policy was put into place).

[cassandra]

Dear Hazmat write to whoever is in charge of your care. I remember reading (I'm not in US) that when your Dr prescribes, even Davita has to fulfil that prescription. And seriously start to learn to cannulate yourself.

A problem is that nephs are often under contract to the dialysis facility and will only prescribe within corporate policy.

My neph is great, but he will not prescribe a 200 or 250 filter unless the Fresenius P&T committee approves the extra expense - which requires that the patient not "make goal" at 4.5 hours of chair time.   Fresenius will not allow someone who meets goal with 4.5 hours to get a 200 filter instead of a 180 - after all, the patient's time is cheaper than the bigger filter.  (they grandfathered patients on the larger filters before this cost saving policy was put into place).

When Hazmat can cannulate himself, so the techs don't spend any time on him needling (because he cannulates himself) that would be a cost cutting exercise too. It must be worth a try?

Love, Cas

[Hazmat35]

Hazmat, who's your provider? I'm with Fresenius.

Davita