Anyone have experience using the buttonhole technique when cannulating fistulas? We have started this in our unit on a few patients and are not having very good luck switching from sharp to dull needles. Any advice? Bevel up or down? How important is it that the same person be the cannulator for the first , say, 3 weeks? Our only inservice was a video on the technique. We have some very frustrated patients and also staff. Thanks in advance for any help.

I could elaborate here but I will direct you to the patient discussion site on renalweb.com You will see the home dialysis section and then the button-hole info will be there.Be aware that the button holes vary from patent to patient and the time is just a guideline.I have patients who train other patients utilizing this technique.It gets easier and easier.-

I heard JMS is coming out soon with a video on the buttonhole. You may want to call your local rep. Medisystems also has a video.

I think it is disgusting that companies would onl provide a video when someone's LIFELINE is critical to their well being. Debbie Brouwer has been invovled in KDOQI as well as buttonhole and if you put into your search engine you can obtain alot of information. How can companies truly believe that patients are receiving the best care when their training is greatly lacking. THis is a perfect example. Also, Medisystems can help with teaching staff and maybe go to your unit. This is most disturbing that staff are not adequately trained

The staff doing buttonholes at our clinic use a sharp needle for 8-9 treatments before using a dull needle. It is best to have the same person stick the patient during the first 8-9 treatments, but not always possible. However, we did figure out that a right handed person will use a different angle than a left handed person, so keep this in mind. We currently have approximately 5-8 patients using this technique and it is going well. Hope this helps!

This makes me scared as I am interested in the button hole technique but they haven't even started using my fistula yet (yes, I am a patient .. I will check out the forementioned patient thread on this afterwards). No nurse talked to me about this but a fellow dialysis patient suggested that I start the button hole technique right away as he wishes someone would have suggested the same to him. He didn't do it from the beginning but he does do it now. He doesn't like the nurses to do it and he does it himself. I was watching him as he took tweezers to pick off the old scabs and then would proceed to pick himself with the dull needles. He had trouble with one of them however and had to revert back to a sharp one.

Please do not make this a difficult procedure.We do this all the time and there are some variables that may occur.Before you start gather all the info and read all about this exciting technique.There will be plenty of help available to you..

quote:

Originally posted by old school:
Please do not make this a difficult procedure.We do this all the time and there are some variables that may occur.Before you start gather all the info and read all about this exciting technique.There will be plenty of help available to you..

hopefully but I am still scared. I guess I shouldn't be. I am trying to get all the info .. that is why I am here ...

They finally started using my fistula but are not teaching me button hole yet. What do I need to do to prepare?



also ... why when I logged in this time I am showing up as a different user? I logged in under the exact same email as last time. i don't get it...

Is this normal?

Buttonholes started Dec 8th 2006, blunts used once on Arterial but all times afterwards the blunts just push the fistula around under my skin so they had to go back to sharps.

Not able to use blunts successfully until Jan 31st 2007.

I tell them how on homedialysis.org it says that I should have the same cannulator until the buttonholes are established. My buttonhole nurse said that the buttonholes on me are not yet established, or at least she won't say they are until the needles go into the buttonholes every time without problems and any nurse can cannulate me.

I asked her why I have a different nurse cannulating me each time and she said it doesn't matter and she wouldn't read the print out from that site that I printed out.

Other HD patients have said that with a different nurse cannulating me each time that a few things could be going wrong:

• The nurses are going in at different angles so even though they are cannulating in the same spot on my skin, the needles are going into the fistula at different spots.
  
• With different nurses cannulating me they are causing scar tissue to develop and that would be why the needles don't go into the fistula but just push it around.
  

What do you think? Any and all advice very much appreciated!!

angie you are absolutely right with your research..here is a question for you...have you ever thought about putting in the needles yourself..that way you avoid the problem of having a different nurse needling you everytime! that's how we do it on our unit

I would once my buttonholes are established. That is the plan anyway .. I just wish the nurses were more compitant.

no i mean you establish the buttonholes that way you always have the right angle etc...this is the best way to ensure it is done right..believe it or not...well at least that is my experience

Well, I have been told that a LOT of people establish their buttonholes themselves but I don't know how well I could do that since mine roll and I need more than 2 hands to work with mine.

I could do the arterial but the venous I need to pull back on the skin because there is a dip so I just discovered lately that is why the buttonhole doesn't line up. Pulling back on it last time worked and it finally went in with only little trouble. We realize the buttonhole is there but just that my fistula rolls so much that it is hard to fine how it is lined up (skin entry point and buttonhole on the fistula itself).

Does that make sense? The nurses have said that mine is more difficult than most but not the first they have seen like that.

I am just glad they finally stopped using sharps on me since the other nurse said "Oh well, another patient has to use sharps all the time so it is no big deal. We will just keep doing that if we have to!" without thinking about any repricussions.

What I am trying to do here is visualize, understand, and learn as much as I can. It is hard for me to learn without being able to see through my arm actually what is happening and what is going wrong.

There doesn't happen to be able flash videos online or anything that shows reasons why buttonholes might not develop as fast and why, is there?? I would love that.

ONLY SHORT TIME TO RESPOND..DOES YOUR UNIT HAVE HANDHELD ULTRASOUND UNIT? YOU CAN THEN USE THAT TO VISULAISE WHAT IS GOING ON?