I have very poor veins.I am now doing dialysis without catheter or fistula as they have all clogged. I do direct inject into a particular vein and artery 3times/wk for 6 months already. Can i do this for long term use?? Are there ways of keeping them in good condition?? How do i prevent infection and thrombosis?? Are there any signs or foreseeing infection and thrombosis??

Dear Louise,
How do you cannulate into the artery and vein? Is the artery in your lower or upper arm? Was it part of your old fistula? Was a fistulagram (dye x-ray test) ever been done of your old fistula or the new sites you are using? Prevention of infection requires good skin prep prior to the needle cannulation. The best way is to start with a good srcub at the sink with soap and water just prior to the skin prep and cannulation. What bloodflow rate do you use for dialysis. Do you monitor per pump arterial and venous pressures? Signs of thrombosis can be found by monitoring the pressures. Would love to hear more about your access.

Thank you for replying so quickly. I have 5 operations for fistula which all clogged up very fast .Then i went on for a catheter on my right lower arm,which lasted for 8months.
My doctor advised me to go on peritoneal dialysis ...which failed immediately after the 2nd day of surgery. Because my catheter clogged up...there is still a small point to get the artery located at the joint of my lower and upper arm. As for the veins...the doctor found a spot on my other arm(joint)
to do direct inject. I did not undergo any fistulagram / venograms etc. I do not want to go for any more surgery for grafts/catheter/fistula as i know i have poor veins. My present blood pump is 195
My doctor just found another vein on my right
lower arm. Is it wise to rotate the usage of the 2 veins so that they could have more rest
and recover quickly??

Where do you live? In the US we monitor the adequacy of dialysis with a lab result called Kt/V or URR. How well do you dialyze at such a low blood flow? The rotation of the viens might be a good idea- never used a non-fistula or graft for regular dialysis. Not sure if the buttonhole idea might be better for you. Your case is not a common case in the US.

I live in Hong Kong, and I already have the best doctor to attend to me..All my vascular access operations were done by the best surgeon in town...the surgeon does not have any more confidence to operate on me. I was told my veins were very sensitive and contracts easily and not so visible to eyes.
Because I am small in size therfore, my blood flow is 195( b4 it was only154)...Most chinese are around 200-250
Is the meaning of button hole technique means insert the same point onto the vein each time?? Can it work too if there is a scalb formed?
By inserting on the same point ,will there be any damaged caused on the vein?
Can the needle still be inserted on the point where there's a bruise?

The buttonhole cannulation technique is not in widespread practice in the US. In Europe it has been widely used for 30 years.
In this months issue of Nephrology News and Issues there are the results of a EDTA/ERA survey showing that Buttonhole is performed "routinely" by 20% of the 100 dialysis units in 20 countries polled and done "sometimes" by 39% of the survey respondents.

The buttonhole technique is most successful when a "single sticker" is used. The same person cannulates the blood vessel at the same angle and depth of penetration each time. After a couple of weeks a scar tissue tunnel develops. The cannulation then becomes less painful and easier for the cannulator. They simply follow the established scar tissue tunnel.

Buttonhole or "Same Site Cannulation" technique is frequently used in donor pheresis. The anti-cubital vein is used by most platlet donors. Since they donate frequently they like to use the same site because they don't get their arms all marked up with needle puncture scars. Plus the sticks become less and less painful as scar tissue tunnels are formed.

This buttonhole technique sounds like it might be what you need since your sites for cannulation are so limited. Dr. Twardowski, who I understand has recently retired from the University of Missouri, was I believe the first MD in the US to use the buttonhole technique. The scab that forms over the puncture site between uses should be removed prior to cannulation. Site disinfection should be performed as you would with any cannulation.
There is a video produced by Dr. Twardowski, featuring the patient Debbie Brouwer mentioned, George Harper. The video nicely demonstrates the use of the buttonhole technique. I think you can still get copies of the video by contacting the Nephrology department at the University of Missouri. Also there are some articles in the US nephrology journals on this topic.

Good luck to you !