= BUTTONHOLE TECHNIQUE - The definitive quide =

[Epoman]

Wow! I am getting more and more scared of travelling but now that my fistula finally has stopped blowing (they fixed it with the last fistulogram) I am getting ready to go to mornings to have the buttonhole taught to me. I am still scared to stick myself but as soon as the catheter comes out I can finally learn (I hope!)

I've been telling you for months Angie, after you learn to stick yourself you will never let anyone stick you again. 

[angieskidney]

Wow! I am getting more and more scared of travelling but now that my fistula finally has stopped blowing (they fixed it with the last fistulogram) I am getting ready to go to mornings to have the buttonhole taught to me. I am still scared to stick myself but as soon as the catheter comes out I can finally learn (I hope!)

I've been telling you for months Angie, after you learn to stick yourself you will never let anyone stick you again. 

I think anyone who does buttonhole is courageous .. I mean .. the sticking yourself is scary! Yet, I can see myself doing it! I know that ones the paths are developed it would be easy to stick oneself. Just at this rate, no one is even doing buttonhole on me, much less teaching me. But I hope that time is coming up soon. All I can do is hope, right?

[Black]

Great guide Epo!

Amber, Angie et al,

It is important to let only have one person develop buttonhole sites.  It does sometimes pose some scheduling concerns, because that means the same person always needs to be available to stick you, at least for a few weeks.

This is why you should begin sticking yourself with sharps, and be the only one to stick yourself while developing the buttonholes.
You are the only person who will consistently be there.
What happens when you travel down state-side and dialyze at a clinic who's never heard of it?  They typically associate buttonhole with "lifesites" and will sometimes not let you dialyze there.  I've run into this multiple times in California.

The trick I found was to simply tell them I stick myself, and that I bring my own supplies (don't even mention buttonhole).  Then take your own needles with you (ship them ahead of time or put in checked baggage obviously) and stick yourself.
Otherwise your buttonholes won't get used, and you'll have someone with God knows how much experience sticking your fistula with a sharp.

Not a good place to be in my not-so-humble opinion.

My $.02  (worth much less when adjusted for inflation)  <G>

Looks like good advice to me -- will certainly be helpful when my husband starts.

[angieskidney]

I found out I am waiting on nurses that are trained in it to come back from vacation because the same nurse has to do it all the time until I would learn it. But as I realized it may come sooner than I thought, I suddenly got very scared 

You can bet I will be reading this thread over and over again til it is memorized when I start learning

[slothluvchunk]

You'll do just fine - regardless of how scary it might be.

you'll do fine because you'll be informed, have realistic ideas and expectations, and most importantly, because YOU are the one giving and receiving.

[angieskidney]

I just found out today there is no opening for me yet to switch to the earlier shift so I can't learn the buttonhole technique yet. ... guess I will see about next month

[Panda_9]

Have you thought more about doing it yourself angie?

[angieskidney]

Have you thought more about doing it yourself angie?

How would I learn to do it myself? I need to be taught first! I don't want to just experiement on myself 

[Panda_9]

Excuse my confusion angie 
I didnt actually mean for you to experiment on yourself lol You could get the nurses to teach you cannulation, so then when a spot is available to learn buttonhole, it will be a breeze. It is so frustrating, as us patients who already do it, know that its really not that hard to learn. It is a shame that all nurses dont know about it. I would be making them all learn it!

[angieskidney]

I am really scared to learn and I think the nurses are scared to teach us.

[Epoman]

I am really scared to learn and I think the nurses are scared to teach us.

Honestly Angie there's nothing to it! You find a spot that works good, use a SHARP needle about 5-10 times in the same spot, then you start using the BLUNT needle. When you finally do it you will look back like I did and wonder why you worried so much. 

[Panda_9]

Hey epo, did you really need to caps the "sharp"? We're trying not to scare the poor girl lol

[Epoman]

Hey epo, did you really need to caps the "sharp"? We're trying not to scare the poor girl lol

LOL!

[angieskidney]

Well I don't really scare easily since I have been having to go through so many things to do with renal failure since I was a kid (9 yrs old).

Last night (Friday's dialysis) my fistula blew again Twice. But they have already scheduled to take the catheter out so I am nervous. I asked if maybe that should be cancelled but they said no it was probably only a fluke. I feel like they don't take me seriously. Even when I asked the Neph if since I never get any infections in the catheter if maybe he should leave it in longer and he said 2 weeks is the minimum and I have had mine in for 3 weeks of fistula working no problem (until last night). I want to do buttonhole but they told me again that there is no room on the earlier shift right now to learn buttonhole. I don't think they will let me just "wing it" The nurse I had said that my fistula is so hard and rolls. Well that sounds to me just like my veins normally as when they are poked with needles a lot they get hard. That has been happening for the last few years but when I asked the surgeon if it would be a problem he barely listened to me, just saying, no it isn't the same thing. Well it sure sounds like my fistula is doing the same thing as my veins normally do

[Rerun]

Angie.  You take charge.  You call and cancel the catheter removal.  You tell them "I'm taking charge of my health care like everyone is telling me to do and I do not feel comfortable taking out the catheter until my fistula works for 2 months without a problem".  If you don't have an infection then leave it in.  OR you will be putting it right back in.  You can run out of catheter sites too ya know.

Also, you can bargen with them.  Tell them when you learn button hole you will get your catheter out.

[Zach]

The nurse I had said that my fistula is so hard and rolls. Well that sounds to me just like my veins normally as when they are poked with needles a lot they get hard.

Veins that roll are not anything out of the ordinary.  They should stabilize the vein between two fingers before they stick it. That is SOP (Standard Operating Procedure).  Maybe a tourniquet should be used too.  I use it above my venous site and never a miss.  Just remember to remove it after the stick ... or the vein might just clot.

[angieskidney]

Angie.  You take charge.  You call and cancel the catheter removal.  You tell them "I'm taking charge of my health care like everyone is telling me to do and I do not feel comfortable taking out the catheter until my fistula works for 2 months without a problem".  If you don't have an infection then leave it in.  OR you will be putting it right back in.  You can run out of catheter sites too ya know.

Also, you can bargen with them.  Tell them when you learn button hole you will get your catheter out.

VERy good advice! Thanks Rerun!!  I will be calling my Neph direct Monday before I go to dialysis! Thanks!

The nurse I had said that my fistula is so hard and rolls. Well that sounds to me just like my veins normally as when they are poked with needles a lot they get hard.

Veins that roll are not anything out of the ordinary.  They should stabilize the vein between two fingers before they stick it. That is SOP (Standard Operating Procedure).  Maybe a tourniquet should be used too.  I use it above my venous site and never a miss.  Just remember to remove it after the stick ... or the vein might just clot.

The tourniquet is always used. And the nurse on Friday did stabilize it between 2 fingers but still it blew twice (goose egg). Had to use my catheter. Which is why I am going to call the Neph. I asked the nurse and she said "it might just be a fluke" but what would she have done if I didn't have my catheter? She said they would just put one back in if they really needed to. Well I kinda want to prevent the hassle!! 

And I really feel they should take me seriously about the Buttonhole and not keep putting me off since my fistula is not going to be as easy to poke in the long run with how I develop scar tissue ...  I really feel they do not take me seriously at all because of my young age 

[Epoman]

Angie.  You take charge.  You call and cancel the catheter removal.  You tell them "I'm taking charge of my health care like everyone is telling me to do and I do not feel comfortable taking out the catheter until my fistula works for 2 months without a problem".  If you don't have an infection then leave it in.  OR you will be putting it right back in.  You can run out of catheter sites too ya know.

Also, you can bargen with them.  Tell them when you learn button hole you will get your catheter out.

VERy good advice! Thanks Rerun!!  I will be calling my Neph direct Monday before I go to dialysis! Thanks!

The nurse I had said that my fistula is so hard and rolls. Well that sounds to me just like my veins normally as when they are poked with needles a lot they get hard.

Veins that roll are not anything out of the ordinary.  They should stabilize the vein between two fingers before they stick it. That is SOP (Standard Operating Procedure).  Maybe a tourniquet should be used too.  I use it above my venous site and never a miss.  Just remember to remove it after the stick ... or the vein might just clot.

The tourniquet is always used. And the nurse on Friday did stabilize it between 2 fingers but still it blew twice (goose egg). Had to use my catheter. Which is why I am going to call the Neph. I asked the nurse and she said "it might just be a fluke" but what would she have done if I didn't have my catheter? She said they would just put one back in if they really needed to. Well I kinda want to prevent the hassle!! 

And I really feel they should take me seriously about the Buttonhole and not keep putting me off since my fistula is not going to be as easy to poke in the long run with how I develop scar tissue ...  I really feel they do not take me seriously at all because of my young age 

I'll tell you again, DEMAND IT. You are the boss, it is your body. Didn't I tell you NOT to remove your cath to soon? Good thing you listened. Do you have a social worker? or case manager? You need to stop being so soft spoken about this situation and do what ever it takes to use buttonholes. With your fistulas problems the buttonhole technique would be ideal. In fact the buttonhole technique was made for people with difficult or limited spots for access. Can you change centers?

[kitkatz]

I agree with the Epoman. Stand up for yourself.  You only have one you!  Give them genuine hell until you get what you want.  Start with a written request and a timetable to the head nurse and DON. Then take names and kick some ass!

[Panda_9]

Did you know that the buttonhole method was developed by accident?

[Epoman]

Did you know that the buttonhole method was developed by accident?

Yes, if you read the .PDF I posted in the 1st post of this thread you will read how and why it was created or discovered. Basically a doctor had a patient with a fistula and the patient only had a very small area that was useable.....well just read the .PDF to read the whole story.

[angieskidney]

Well it doesn't seem like anyone listens to me but I have finally gotten ahold of the new social worker who seems MIA. They have scheduled me for the catheter removal this Tuesday and have told me they "think" there is no opening for me to learn buttonhole .. so now I have gotten the new social worker involved saying how I feel like I don't matter and I want answers and don't want my catheter removed yet. I will see what will develop from this in this short of time. They keep telling me, "if you need it in again it is not hard to get it back in". Ya but what if I am at dialysis, need dialysis, and they need to use the catheter but it is out? Sometimes I wonder where their brains are!

I think she is also going to look into the buttonhole scheduling for me.

[BigSky]

Well it doesn't seem like anyone listens to me but I have finally gotten ahold of the new social worker who seems MIA. They have scheduled me for the catheter removal this Tuesday and have told me they "think" there is no opening for me to learn buttonhole .. so now I have gotten the new social worker involved saying how I feel like I don't matter and I want answers and don't want my catheter removed yet. I will see what will develop from this in this short of time. They keep telling me, "if you need it in again it is not hard to get it back in". Ya but what if I am at dialysis, need dialysis, and they need to use the catheter but it is out? Sometimes I wonder where their brains are!

I think she is also going to look into the buttonhole scheduling for me.

Everything you need to know to start a buttonhole on your own. 
http://www.homedialysis.org/v1/types/buttonhole.shtml

[Epoman]

Well it doesn't seem like anyone listens to me but I have finally gotten ahold of the new social worker who seems MIA. They have scheduled me for the catheter removal this Tuesday and have told me they "think" there is no opening for me to learn buttonhole .. so now I have gotten the new social worker involved saying how I feel like I don't matter and I want answers and don't want my catheter removed yet. I will see what will develop from this in this short of time. They keep telling me, "if you need it in again it is not hard to get it back in". Ya but what if I am at dialysis, need dialysis, and they need to use the catheter but it is out? Sometimes I wonder where their brains are!

I think she is also going to look into the buttonhole scheduling for me.

Everything you need to know to start a buttonhole on your own. 
http://www.homedialysis.org/v1/types/buttonhole.shtml

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!

[angieskidney]

Well it doesn't seem like anyone listens to me but I have finally gotten ahold of the new social worker who seems MIA. They have scheduled me for the catheter removal this Tuesday and have told me they "think" there is no opening for me to learn buttonhole .. so now I have gotten the new social worker involved saying how I feel like I don't matter and I want answers and don't want my catheter removed yet. I will see what will develop from this in this short of time. They keep telling me, "if you need it in again it is not hard to get it back in". Ya but what if I am at dialysis, need dialysis, and they need to use the catheter but it is out? Sometimes I wonder where their brains are!

I think she is also going to look into the buttonhole scheduling for me.

Everything you need to know to start a buttonhole on your own. 
http://www.homedialysis.org/v1/types/buttonhole.shtml

haha I found that site 2 days ago and put it on my own forums lol

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!

I need Epoman to come to my unit and raise hell for me