Archive for the ‘buttonhole technique’ Category

Aaaah, the buttonhole.

Some of you have lived this process with me (the development of my buttonhole sites), and so I feel a need to update everyone that they are still working well.

Extremely well in fact.

It’s gotten to the point that the needles just sort of slide right in, with minimal persuasion from me.
The sites have not gotten any larger, and are very easy to use. If I would have been using them since the beginning I feel my arm would look a lot more “normal” now.

I strongly encourage any of you who are unfamiliar with this to read more about it.
There are very few contraindications – the most prevalent of which is simply the Dr. or clinic’s lack of familiarity with it.
Many doctors and clinics tell their patients that they are not candidates for buttonholes for many reasons, but I fear that frequently this information is incorrect.
Many more patients could be utilizing this technique than are now, and it is the fault of the dialysis industry, and the doctors coupled with them. It’s yet another example of how healthy people who take care of sick people never fully realize how their actions affect the end user.

Sorry,
After my traveling rant – I forgot to give a buttonhole update.

The buttonhole sites are going awesome. Every treatment or two I run into some resistance – no two sticks seem to be identical. I have been able to get them in though, and have figured out how to “back out” and try again through my buttonhole track.

Arterial and venous pressures are awesome, and I have no pain at the sites. For those of you thinking about this: DO IT.
There is no contraindication that I have found. Why doctors aren’t offering this to everyone is beyond me.
Advocate for yourself, and educate yourself. This is the key. If you feel this technique is good for you, push for it!

And again: see you all next week.

We’re traveling to California next week, so my apologies ahead of time if you don’t see anything for a week or so.

As always, any trip must first be arranged weeks in advance – to coordinate between the dialysis clinics, and make sure all the paperwork is in order. You’d think that since these companies are by and large ‘for profit’ entities, they’d have a “come as you please and dialyze” service. Nothing like that quite exists yet.
So to take a trip, you must first find a clinic where you’re going, then make sure they even accept traveling patients. If they do, you move to the next step – coordinating schedules, faxing patient histories, Dr’s orders, etc. This can be a bit of a pain, and sometimes it seems as if the whole process is very delicately balanced.
You sort of just wait for the bottom to fall out. Not once have I traveled and had everything go as it was supposed to. This is of course to be expected, we are playing the game of Life after all. But leaving home and not being certain that the arrangements for dialysis will be in place before you get there is a bit disconcerting.

More than two weeks ago I set the ball in motion. I even did the leg work – I found the clinic, called them, checked their schedule, (actually Anna found the clinic, but still…). The social workers then should communicate with each other, and figure out all of the particulars. Everything seemed to be going smoothly – orders were faxed, calls were made, questions asked. I should have known better. On Wednesday Anna asked me to check and make sure everything was set (I figured no news was good news – but I’m an idiot). Well, sure enough there was a mixup. Another patient here is traveling, and supposedly there was some confusion as to who was going where, when. So apparently no real communication had been made, and today the clinic where I’m going let our Administrator know that I can only dialyze there on TTS (Tuesday Thursday Saturday shift). This poses two problems. One, I will leave here on a Tuesday, meaning I won’t dialyze between Monday and Thursday. That’s essentially two weekends in a row. Ok, I can handle that. But we’re flying back the following Tuesday, which means I’ll have an über-weekend between Saturday and Wednesday (when I will return to my clinic).
After thinking about it for a bit I realized there was no way that was going to work.
Our F.A. (Facility Administrator) is awesome in the absence of a social worker here – In 30 minutes he was able to do more “legwork” than three past social workers. Typically the social worker takes a lot (LOT) of time to get things like this done, and when things need to be done quickly, it’s nice to have someone decisive, and better still, proactive.
Well, before leaving today, our F.A. let me know that he had found another place willing to let me dialyze there on MWF (Monday Wednesday Friday shift).
Awesome – after nearly blowing my top earlier, all is well again in the Universe.

Lesson?
Don’t try to arrange family trips to quickly.

No … the lesson is chill out! None of this stuff is worth getting worked up about. It all works out.

See you all next week

After a few tries at cannulating my arterial buttonhole site with no success, I marched into treatment today determined that I was going to make it work.
As I mentioned earlier it was obvious that the track was developed, but for some reason I just wasn’t able to get the buttonhole needle in.
I asked the tech putting me on to hold my fistula in place, as the last few times it had appeared to roll away from the needle.
She held it straight, and thankfully the needle just slid right in – “like buttuh”.

So I guess I’m officially a buttonhole patient now. I’m much less apprehensive about travel now, knowing that not only can I stick myself, but I can stick myself easily with these newly established buttonhole sites.

I’ve also learned that it is in no way abnormal to have one site develop faster than the other. It’s also not uncommon to have to “spit on it” and really push that needle in there.
If you’re establishing buttonhole sites and having trouble, stick with it. I was adamant about continuing to develop this site rather than move to a new spot, and here we are a week later with it working fine.
Feel free to email me if you have questions about this experience.

As some of you know, buttonhole, or “constant site” cannulation is nothing new. Some of you are probably using buttonhole technique, and still others have probably read about it here, as I have described my experience with it.
Well today I found an interesting article about reducing the time it takes to establish buttonhole sites.
You can read the article here.

One thing I find interesting, is that the article starts off by stating that it typically takes 2-3 months to establish buttonhole sites. Has this been the case with any of you? From everything I’ve read the “normal” time is 6-9 cannulations, that’s 2-3 weeks. Certainly it must take longer sometimes, but is 2-3 months really the norm?
I bring this up, because the article then proceeds to explain a technique wherein a “peg” is placed in your arm after the needles are pulled after your treatment, and this peg is left in until your next treatment. Obviously this gives something for your track to graft around, so it seems to make sense (in theory anyway). What perplexes me, is that their results are viewed as a success, because the time to create the sites is shortened to 2-3 weeks.
If it takes most of us 2-3 weeks anyway, why would this study be seen as a success?
Also, is there increased risk of infection? The study indicates that nobody had serious problems with infection, but with a sample size of 37 patients is that really telling us anything?
It is an interesting idea, but I would think a slightly more scientific study would be needed to conclusively say this was a safe way to rapidly establish buttonhole sites.
What do you think?