= BUTTONHOLE TECHNIQUE - The definitive quide =

[BigSky]

Yeah she can start the buttonhole using sharps, but what happens when she needs the "Blunt" needles and they do not order them for her?  She needs to RAISE HELL bottomline. DEMAND IT!

Well from what I have gathered the unit already carries the blunts so it would be merely a formality of having the doctor order it to be used.  Wouldn't it?

[MattyBoy100]

Does anyone know if the buttonhole technique is used in the UK?  I will ask my unit about it tomorrow.  My arm looks like it has a "track"  along my fistula where I have been pierced in a new spot every session.  If Epoman says there is no pain then I am williing to try this technique if my unit will do it. Sorry Epoman, not cannulating myself yet!!!

[Panda_9]

MattyBoy, the sooner you cannulate yourself, the better it will be for your fistula, and for you. There is no reason to put it off and put it off, you just have to make yourself do it. It took me a few weeks of watching and learning, and then I made myself do it. After you are used to doing it yourself, you wont want anyone else to cannulate you.

[angieskidney]

Yeah she can start the buttonhole using sharps, but what happens when she needs the "Blunt" needles and they do not order them for her?  She needs to RAISE HELL bottomline. DEMAND IT!

Well from what I have gathered the unit already carries the blunts so it would be merely a formality of having the doctor order it to be used.  Wouldn't it?

For me I just need the nurse that does buttonhole to start it. For some reason my dialysis unit seems to disorganized lately and I don't know what has changed. I even talked to the Kidney Foundation executive director since they are in the same building and she said to talk to the renal social worker .. who hasn't been around for 2 months and is on vacation this week ...

[MattyBoy100]

I spoke to my unit about buttonhole tonight.  They said they do not do it nor recommend it either.  They don't get blunt needles from their supplier and I was also told that the very reason they don't buttonhole is due to

1) The risk of infection being that much greater.

2) By using the same spot over and over, the fistula develops large welts and the skin becomes harder.

3) There is a possiblity of poorer blood flow i.e. trickling blood through the veins.

I'm not saying anyone is right or wrong cos I don't know, but those are the reasons I was given for not doing buttonhole in my unit.

[angieskidney]

I spoke to my unit about buttonhole tonight.  They said they do not do it nor recommend it either.  They don't get blunt needles from their supplier and I was also told that the very reason they don't buttonhole is due to

1) The risk of infection being that much greater.

2) By using the same spot over and over, the fistula develops large welts and the skin becomes harder.

3) There is a possiblity of poorer blood flow i.e. trickling blood through the veins.

I'm not saying anyone is right or wrong cos I don't know, but those are the reasons I was given for not doing buttonhole in my unit.

Yes but for me it is best. Why? Because I have done extensive research myself and they have limited spots to stick me so sadly they are already sticking my arterial in the same spot and lately it is leaking because they are sticking it into scar tissue (that is right .. 14 months of Hemo and only had the fistula since May and already have scar tissue that leaks when the needle is cannulated through it). I don't know if that is normal but I am worried because they don't have many options for the arterial. This is why I want buttonhole. If they are gonna cannulate me in the SAME spot almost every time then they might as well do it right!! Right??

[Panda_9]

"1) The risk of infection being that much greater.

2) By using the same spot over and over, the fistula develops large welts and the skin becomes harder."

I thought the infection risk was less? I dont have any welts or hard skin. I have been doing buttonhole from the very start, been 18 months now. I just have 2 holes, that havent been a problem, except the occaisional time when you need to use a sharp. In my opinion I think button holes are better.

[Epoman]

I spoke to my unit about buttonhole tonight.  They said they do not do it nor recommend it either.  They don't get blunt needles from their supplier and I was also told that the very reason they don't buttonhole is due to

1) The risk of infection being that much greater.

2) By using the same spot over and over, the fistula develops large welts and the skin becomes harder.

3) There is a possiblity of poorer blood flow i.e. trickling blood through the veins.

I'm not saying anyone is right or wrong cos I don't know, but those are the reasons I was given for not doing buttonhole in my unit.

Bottomline is the people in your unit are idiots, and you are welcomed to Quote me to them.  "People are fearful and ignorant of things they know nothing about"

Let me reply to their statements:

1) WRONG! The risk is the same, it all depends on your "aseptic technique".
2) WRONG! SO VERY WRONG!
3) I can get higher flows than EVER before, I used to get 400-450 max in-center, now I can hit 550-600 sometimes depending on my position, I usually run 480.

So yeah, again I'll say, the workers at your center are idiots. 

- Epoman
Owner/Admin

[MattyBoy100]

I printed off the information from the link that you gave us Epoman and took it into my unit.  A different nurse to the one I spoke to previously said that her and one other were going to another unit to be trained on buttonhole technique!!!

Methinks that maybe there is a communication problem at my unit!
 

[Epoman]

I printed off the information from the link that you gave us Epoman and took it into my unit.  A different nurse to the one I spoke to previously said that her and one other were going to another unit to be trained on buttonhole technique!!!

Methinks that maybe there is a communication problem at my unit!
 

Way to go MattyBoy my boy! YOU are your best advocate, just glad I can help anyway I can. 

[MattyBoy100]

I have been chatting to my unit extensively about this Issue ( sorry to keep going on guys) and they have said that I can buttonhole if I wish once the nurses are trained provided I cannulate myself.  I've been thinking about self-cannulation anyway and may try it soon but not brave enough yet.  Anyway, I have been told that I have an excellent long fistula and don't really need to buttonhole as there are plenty of access sites.

Now you guys are all saying go for buttonhole etc but I need to know if there is definitely not any large bumps where you have been cannulating in the same spot.  Pics as proof would be good please because I have offered to be the first one in my unit to buttonhole and I want to be sure I am doing the right thing if they go ahead with it.

[jbeany]

Have you seen Bill Peckham's video of him cannulating himself with his buttonholes?

Here's a link - http://www.dailyhemo.org/2/page.php?7

I can't use buttonholes with my graft, but I've been watching a lot of these videos because I want to do home hemo on a nxstage, and I need to get over my needle phobia.  The more I watch, the less seeing it done bothers me, so my attempts to desensitize myself must be doing some good!

[angieskidney]

That vid is good! 

I still have yet to start buttonhole (they are sooo slow in my unit you might have noticed) but once I start I will talk about how it goes here and on my forums as well

[Panda_9]

MattyBoy, long fistula or not, I still think its better to buttonhole than use the ladder method. I dont have a photo but I have been using the same 2-3 buttonhole sites for 18 months and they are not raised or bumpy. They are just little holes. The arterial has a small amount of scar tissue around the exit site, however I get keloid scars which is probably why that has happened. It doesnt affect my ability to cannulate. As much as I dont like cannulating myself, it is so much easier to buttonhole and so much less stressful. You know exactly where you are going to stick it, and do it the same every time. It is much more comforting in my opinion. On the rare occaision where I have had to use a sharp, I find it much more stressful and nerve racking. I have a snakey fistula, so I feel confident using the blunt needles knowing that there is next to no risk of infiltration. Having to use a sharp overnight can be a bit daunting, as you have to be careful not to move too much during sleep.

[MattyBoy100]

I watched the video links and boy they were really enough to put me off especially Gus, have you guys seen the size  of his fistula arm?  What a mess it is, at least it looks that way to me.  And in Bill's film, why was he taking BP on his fistula arm?  My unit always take BP from my right arm ie my non-fistula arm.

You know the worst bit was picking the scabs off.  That looked so unhygienic the way Bill was doing it by using a needle to pick them off.  The pdf download says you must NEVER use needles to pick scabs off but soak them  (the scabs) in alcohol first.  Another thing is Bill doesn't wear gloves, just cleans his hands in solution then picks up a needle with those same bare hands.

Come on guys, surely this isn't the sort of thing we are advocating here?  Yes, he may have been doing it for years but looks to me like he is asking to get an infection.

Those of you with experience in these matters, please enlighten me and tell me if I am wrong in my observations.

[angieskidney]

I watched the video links and boy they were really enough to put me off especially Gus, have you guys seen the size  of his fistula arm?  What a mess it is, at least it looks that way to me.  And in Bill's film, why was he taking BP on his fistula arm?  My unit always take BP from my right arm ie my non-fistula arm.

He is using the cuff not to take pressure but to act as a ternequet (is that how it is spelled??). He wouldn't be able to tie one on.

I don't exactly agree with using sharps to pick off scabs neither ... I have watched first hand a man in my unit and he uses tweezers which he uses ONLY for this purpose and has them wrapped up until he uses them and he cleans everything. He doesn't wear gloves neither however.

[AlasdairUK]

If you wash your hands, you do not have to wear gloves. In centre they where gloves so that the patients blood does not get onto their skin and cause them infections or transfered onto another patient.

My unit will not consider the button hole. I have not pushed the idea. I would one day like to do home haemo and then I would prefer to use blunts and the buttonhole instead of sticking myself with sharps, especially since I use 14 gauge needles.

[jedimaster]

I do buttomhole...I wash my hands and use tweezers to remove tissue... the tweezers are excursively for this, precleaned with alcohol and post cleaned before I put them in a plastic bag. I clean my arm with alcohol before removing the tissue. I use my bare hands...super clean....no problems so far....

[Epoman]

I don't wear gloves either I do use special hand cleaner however, and I use the same pair of tweezers and Scissors. I just use alcohol to clean them. So far no problems.

- Epoman

[Panda_9]

Your washed hands are cleaner than non sterile gloves, so no need to wear them. If for any reason you cant wash your hands (due to injury etc) you can put on non sterile gloves and use the rinse free hand cleanser.

We use blunt drawing up needles to remove the scabs.

[angieskidney]

I finally started Buttonhole on Friday! But my fistula kept having spasms. I figure this is the best place of any to ask .. WHY does that happen???

[Epoman]

I finally started Buttonhole on Friday! But my fistula kept having spasms. I figure this is the best place of any to ask .. WHY does that happen???

I have not experienced that once using the buttonhole. I guess it could be the needle was against the wall causing a spasm? I am not sure. But someone here will reply shortly, I am sure. But I am glad you finally got them to start a buttonhole, after the hole is established you will eventually not even worry about the needles anymore.  You do know that you NEED to learn to stick yourself unless you will be having the EXACT same person stick you from now on. It's all about angles.

[jedimaster]

  Angie!!!...self needling is the way to go. From now on, one less thing to worry about.

[MattyBoy100]

here is a pic of my fistula looking from my shoulder down:

As you can see, it is nothing like Gus' or Bill's in the video.  I don't want my arm to end up looking like theirs if that is what happens when you button hole!

[Epoman]

here is a pic of my fistula looking from my shoulder down:

As you can see, it is nothing like Gus' or Bill's in the video.  I don't want my arm to end up looking like theirs if that is what happens when you button hole!

OK, a few things "MattyBoy100".

First have you seen this thread?: http://ihatedialysis.com/forum/index.php?topic=1297.0 or even this thread: http://ihatedialysis.com/forum/index.php?topic=540.0 which both discuss the rules about pictures. The resolution of your picture is way to big, and the file size is still kinda big, many members are still on "dial-up" If you use that program I offered in the first link, it will solve all of your image problems.

Second, you have been using that fistula less than a year. My fistula looked like yours the first couple of years. Now I have a "Snake" under my arm. And unlike you I got over the "vanity" bullshit and I am glad that my fistula is big, easy to stick and great blood flow.

Third, you need to get over your vanity, because this is the wrong disease to have and be so vain. If you keep using the "rotate" method you will get lumps, the size all depends as everyone is different. And even with the Buttonhole method your fistula will get big. I wish you luck but I suggest you start purchasing long sleeve shirts as your fistula is gonna grow and you are so embarrassed by it. Sorry to be so harsh but it is the truth. Now you may be one of the very few lucky ones and have a fistula that remains small, but I doubt it. I have seen hundreds of patients, and after years of using their fistula it is big. Good luck.

- Epoman