My life with dialysis and kidney disease
buttonhole technique
Buttonhole Update
Feb 9th
We tried Wednesday to do both buttonhole sites with blunt needles … … again.
To our dismay, the same thing happened that happened before, the arterial needle seemed to be “glancing” off the side of the fistula, causing it to push over. And once again, a sharp slid in easy as pie.
So I spoke with two of the buttonhole “gurus” who happened to be visiting our clinic doing the quarterly transonic testing. They both told me that this was fairly normal, and that it was also fairly normal to have one site establish much quicker than the other.
I was told that I most likely had the tunnel established, evidenced by how easily the sharp was sliding in.
Their recommendation was simple: “push harder”.
It seems that it is normal to encounter some resistance with the blunt needles, and theoretically you can’t hurt the fistula with one since it is dull (I’m not going to test this theory however).
So I was simply told to push harder, and “twist”. The thinking is that the needle is entering the track, and then hitting resistance at the vessel wall. Since I’m so careful (after sticking with sharps), I’m probably not exerting enough pressure on the needle to break through this last “flap” of resistance.
Here’s the plan folks, tomorrow I will attempt blunt needles again (the venous site is doing fine with the blunts by the way), and will not be such a pansy with my arterial stick. I’ve been told it is safe to apply three times more pressure than usual with these needles.
3 X !
I’ll let you know how it goes.
It is true by the way that constant site cannulation hurts a lot less. I noticed the very first day that I started developing the sites, that the sharps slid in easier, and hurt much less.
Just sticking yourself hurts a lot less (seriously), so give it some thought.
Arterial: 0 – Venous: 2
Feb 1st
I announced a few weeks back that I had begun self cannulation (sticking my dialysis needles in myself). Everything has been going so well with it, that I decided to go ahead and begin buttonholing.
I think I mentioned awhile ago, that I had seen the buttonhole, or constant-site technique mentioned on the ds_list, but hadn’t gone beyond that. Well after lots of research it seemed to be an obvious choice for the longevity and health of my dialysis access.
If you’re not familiar with the buttonhole technique, I’ll give a brief description. It consists of sticking the *exact* same spot on the fistula every time, until eventually a “tunnel” track of scar tissue forms between the skin, and the fistula below. Once this track has formed, the patient can be cannulated with a blunt needle. Of course this sounds terrifying – having a blunt needle shoved into your arm. But once this track is formed, the needle doesn’t need to cut anything, it basically just glides right into the fistula.
You would hate to “cut” outside of this established track with a sharp needle. And those of you cannulating yourselves know just how sharp those needles are. The blunt needle still has the backeye, and looks much the same, but instead of the bevel forming a point, it is more rounded, and of course not sharpened.
Being able to do this technique means no more jumping around the fistula looking for “good spots”. Once you have two sites established, you use them over and over. Some patients then develop another set of sites to use, but the sticks are no longer rotated around as they are “normally”.
Man, I wish I would have known about this type of cannulation in 2002 when I started hemodialysis. While small bumps are slightly visible where the buttonhole sites are formed, there is no other deformation. My arm however has three and a half years worth of scar tissue, and a couple nice big “deformities” from how the fistula has developed.
It turns out the constant-site technique (or “buttonhole”) is 25 years old. Only recently though, has Medisystems begun to manufacture the blunt needles used.
Now when I mentioned sticking into the “exact” same place I meant it. Not only is the needle trying to enter the same spot on the arm, it is trying to follow the same exact track down to the fistula. This means that the arm needs to be in the same position while the tracks are developed, and also means that the angle of the needle needs to be exactly the same.
I felt comfortable enough with sticking myself that I thought I could handle it, and so I took a special class on buttonhole technique and was then “allowed” to establish the sites.
Well over the last two weeks I have been sticking the EXACT same spots, and have been feeling the tracks of scar tissue form. I was excited Monday to attempt to stick both the arterial and venous sites with the dull buttonhole needles. I sat down, cleaned off my arm, pulled off my scabs (oh yeah, you have to pluck those pesky scabs off each time before re-sticking a site), and prepared to “glide” in the buttonhole needle.
First time was a no-go. The needle just kind of stopped, and seemed to be pushing off the side of the fistula. I was very nervous about this, but quickly realized that infiltration was essentially impossible not having a sharp needle. After trying again though (and not succeeding), it was decided to use a sharp needle, in another place. Disappointed, I still wanted to try the arterial site – and we did.
I lined up the blunt needle, began to insert it, and it basically just slid right in. Wow
So here we are – it’s Wednesday, and again I have one sharp in, and one blunt. I (we) decided to let the venous site establish a bit more before trying to stick it again with the blunt needle. So I think we’ll continue sticking it with the ole sharpy another three times or so, until it’s *really* ready.
What a great feeling! Not only am I putting these needles in myself (I feel like an old pro now), but I’ve become a successful guinea pig with the buttonhole technique. I hope now that some of the patients who really need this can begin to develop constant sites.
Who needs this you ask?
Well, lots of patients have fairly healthy fistulas, but have trouble finding “good” sections of it to use. Some people have a very small section of fistula that works well, and would benefit greatly (especially in the long run) from developing buttonhole sites.
Just because you haven’t heard of it at your clinic don’t assume it not an option. Many clinics I’m learning are “behind the times”, and sometimes need patients to help steer them in the right direction.
As always, take charge of your own treatment – become involved with your life – and stay healthy.
