no they don't.

Sorry it took so long to reply but I haven't been able to log in. So I am posting this as a guest.

I forget the email I had registered here with

Anyway, the buttonholes failed and I am back to rope ladder technique. They said the reason was that my fistula rolled too much so even with the SAME cannulator since it rolled the angle would be different each time no matter what. This was also the reason given for not letting me do it myself.

I have a nurse in my clinic that wants to start Buttonholes on ALL of our fistulas. I thought we only did this with problematic fistulas. What are the pro's and con's of this? I was also taught the the same person had to stick the site for 6 tx's (more if needed) Here they don't care who est. them

Here are the benefits and Disadvantages to button-hole technique. The track MUST be developed by only one person to be successful, otherwise the track will develop improperly, and could cause bleeding around the needle during treatment. If staffing is an issue, two staff can develop their own sets of buttonholes, but this may take longer to establish both sets.

Benefits
Buttonhole results in fewer missed sticks, infiltrations, and hematoma formation.
Prolong life of the fistula.
Cannulation time is decreased.
Patients can self-cannulate / promotes self care and home HD.
Less painful for patients.
Can eliminate the need for anesthetics.
No safety device required on the needle.

Disadvantages/Risks
Can only be used on AVF.
Overcoming “one-site–itis” (which is sticking in same general area, not exact same site).
Requires same cannulator, same angle, same
location until the track/tunnel has developed to be successful (may be difficult to staff).
Difficult with heavily scarred access (multiple problematic needle sticks, lidocaine use, keloid formation, or long-lived AVFs).
Difficult with Upper arm AVF with large amount of subcutaneous tissue or excessive skin overlying the vessel. (Buttonhole tracks need to be straight and if there is no way to keep the skin stable to create a straight tunnel, then the buttonhole technique will fail).

Which Patients?
Any patient with a mature native AVF.
Any potential self- or home-dialysis patient.
Limited area for cannulation sites
(Short area for sticks, Aneurysms with minimal room for needle placement.
When preservation of the access is of critical concern because it is the patient’s last viable access option.

I am a PCT i have been for ten yrs. We buttonhole our pts. but don't use the blunt needles. Some of our pts. bleed for long periods of time. Is this the reason Why. I work for a different company now, but when i was taught to do BH i was taught to convert to the BH needle after 5 or 6 tx's. I was also taught to do both needles up, which vein is always up but to also put the art. up is this correct or does it matter which way the art. goes?

Continuing to use a sharp needle after the buttonhole has develped can cut the track, and enlarge the tunnel. This is probably what was happening with your BH patients. That is why it is important to switch to blunt needles as soon as possible.
As far as the direction of the needles, the venous needle may not always point "up" as a rule. There are many new ways to create a fistula now. Try this, occlude the fistula and listen and feel on either side. The side you hear and feel the pulse is the arterial. Supposedly the arterial needle may be place either way, but the venous needle must always point the same direction the blood is flowing. Personally, I always liked to point my arterial needle towards the blood flow.

Thank you so much for answering my questions. I talked to the charge nurse today and told her i wanted to start using the Blunt needles on the patients I thought was ready and she said go for it, so today I stuck one of the patients with the blunt needles and he loved it. I had the patient next to him ask me for the blunt needles, but had to say " Sorry your a graft".
I am going to start sticking all the ones I can with the blunt needles, and all new fistulas I have requested to put the art. needles up. After reading your reply I will in fact do the test to see which is vein and art. You have been alot of help thank you so much for your time.

Your welcome Vickie, be sure to check with your ESRD Network chapter to find out if they are presenting any cannulation training that you and your team can attend. They will have written educational materials and videos for sure. Great way to be pro-active and a good patient advocate!