Button Hole fistula

Specialties Urology

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I would like to hear from those of you that have created new button holes in fistulas. How long did you need to use sharp needles? What kinds of problems are likely in establishing a new button hole? The nurse that is establishing a button hole in tha unit I work in says that it frequently takes much longer than the articles I have read say. She is naturally the only one sticking this patient. I am concerned that using sharp needles too long will creat more scar tissue, but if the button hole needles are not sliding in easily, what choice do we have? I would like to have more insight into this. An comments would be welcome.

Tracey

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Just curious as to button hole needles. I've worked in dialysis almost 7 yrs. I have never heard of these needles. Please explain the difference.

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Button Hole Needles are not sharp on the edges. You pick one person to cannulate afistula. That person removes the scab from the previous insertion site. Using the same angle, the fistula will be cannulated in the same sites until a "track" develps. Like pierced ears. Eventualy you can cannulate the fistula with needles that have a blunt edge. This process works great on people that have a short area to work with. It helps prevent aneursums from repeated sticks in a small area. It also helps cut down on infiltrations. We use this technique on a few people that have short or "angled" fistulas. Until the area is easily access with blunt needles, the same person canulates that pt.

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Button Hole Needles are not sharp on the edges. You pick one person to cannulate afistula. That person removes the scab from the previous insertion site. Using the same angle, the fistula will be cannulated in the same sites until a "track" develps. Like pierced ears. Eventualy you can cannulate the fistula with needles that have a blunt edge. This process works great on people that have a short area to work with. It helps prevent aneursums from repeated sticks in a small area. It also helps cut down on infiltrations. We use this technique on a few people that have short or "angled" fistulas. Until the area is easily access with blunt needles, the same person canulates that pt.

I've never done the button hole technique. So I probably shouldn't comment. I don't think I go at the same angle every time. I'm not sure it would work. Nor do I want to work MWF every week for 2-3 weeks just to cannulate the same patient. I've stuch fistulas one week that I couldn't stick for beans the next week.

I know this is done in Europe I just don't understand it.

When I learnt to cannulate in the late 80's we used to flip the needle. Even with the back eye arterial needles we use today I still flip fistula needles quite often.. As a matter of fact if I know a fistula shallow or narrow or even difficult I will go in bevel down.

KDOQI guidelines still say we can rotate immediately after puncture, once we level off, or after the needle is in. So why not do it before puncture. I have noticed when practicing bevel down on a fistula needle their is a better flap made, the sites don't tend to bleed so bad, and many patients say, "That didn't even hurt"..

I'm not sure I could establish a buttonhole.. I don't know any of the "big" companies that are encouraging that.

I'm not sure I'd be good at establishing a button hole.

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Thanks for explaining the button hole technique, but I don't think I would be comfortable using it.

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I've never done the button hole technique. So I probably shouldn't comment. I don't think I go at the same angle every time. I'm not sure it would work. Nor do I want to work MWF every week for 2-3 weeks just to cannulate the same patient. I've stuch fistulas one week that I couldn't stick for beans the next week.

I know this is done in Europe I just don't understand it.

When I learnt to cannulate in the late 80's we used to flip the needle. Even with the back eye arterial needles we use today I still flip fistula needles quite often.. As a matter of fact if I know a fistula shallow or narrow or even difficult I will go in bevel down.

KDOQI guidelines still say we can rotate immediately after puncture, once we level off, or after the needle is in. So why not do it before puncture. I have noticed when practicing bevel down on a fistula needle their is a better flap made, the sites don't tend to bleed so bad, and many patients say, "That didn't even hurt"..

I'm not sure I could establish a buttonhole.. I don't know any of the "big" companies that are encouraging that.

I'm not sure I'd be good at establishing a button hole.[/quote

Due to having Dialysis TEch students the discussion came up of bevel down needle insertion. We checked with our Renal Network Access group, and were told absolutely not to insert needles bevel down as the damage to the access is greater.

We do have a few patients with buttonholes--have been using them for our home dialysis pts with good results. We have found that 10 or more sticks with sharp needles are needed.

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I've never done the button hole technique. So I probably shouldn't comment. I don't think I go at the same angle every time. I'm not sure it would work. Nor do I want to work MWF every week for 2-3 weeks just to cannulate the same patient. I've stuch fistulas one week that I couldn't stick for beans the next week.

I know this is done in Europe I just don't understand it.

When I learnt to cannulate in the late 80's we used to flip the needle. Even with the back eye arterial needles we use today I still flip fistula needles quite often.. As a matter of fact if I know a fistula shallow or narrow or even difficult I will go in bevel down.

KDOQI guidelines still say we can rotate immediately after puncture, once we level off, or after the needle is in. So why not do it before puncture. I have noticed when practicing bevel down on a fistula needle their is a better flap made, the sites don't tend to bleed so bad, and many patients say, "That didn't even hurt"..

I'm not sure I could establish a buttonhole.. I don't know any of the "big" companies that are encouraging that.

I'm not sure I'd be good at establishing a button hole.[/quote

Due to having Dialysis TEch students the discussion came up of bevel down needle insertion. We checked with our Renal Network Access group, and were told absolutely not to insert needles bevel down as the damage to the access is greater.

We do have a few patients with buttonholes--have been using them for our home dialysis pts with good results. We have found that 10 or more sticks with sharp needles are needed.

Try bevel down on fistula tubing. See the nice flap it makes.

Does Renal Network Access have peer reviewed research into the subject or any research on the subject.

I read an series of articles in Nephrology Nursing about needle placement. And how many nurses disagree with even the direction of the arterial needle. And one nurse even stated that there is no concrete evidence as to the placement of the needle in the arterial section of the fistula.

Just as there is no concrete research of bevel down. Mostly because I don't believe many are doing it.

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I've never done the button hole technique. So I probably shouldn't comment. I don't think I go at the same angle every time. I'm not sure it would work. Nor do I want to work MWF every week for 2-3 weeks just to cannulate the same patient. I've stuch fistulas one week that I couldn't stick for beans the next week.

I know this is done in Europe I just don't understand it.

When I learnt to cannulate in the late 80's we used to flip the needle. Even with the back eye arterial needles we use today I still flip fistula needles quite often.. As a matter of fact if I know a fistula shallow or narrow or even difficult I will go in bevel down.

KDOQI guidelines still say we can rotate immediately after puncture, once we level off, or after the needle is in. So why not do it before puncture. I have noticed when practicing bevel down on a fistula needle their is a better flap made, the sites don't tend to bleed so bad, and many patients say, "That didn't even hurt"..

I'm not sure I could establish a buttonhole.. I don't know any of the "big" companies that are encouraging that.

I'm not sure I'd be good at establishing a button hole.[/quote

Due to having Dialysis TEch students the discussion came up of bevel down needle insertion. We checked with our Renal Network Access group, and were told absolutely not to insert needles bevel down as the damage to the access is greater.

We do have a few patients with buttonholes--have been using them for our home dialysis pts with good results. We have found that 10 or more sticks with sharp needles are needed.

If you are referring to Dialysis Camp. Those instructions are ELEVEN years old. 1995. Even fistual first says NOTHING about bevel up or down.

Are you using a tourniquet EVERY time on your fistulas.

Are you using clamps. Fistula first say NO CLAMPS

Unfortunately there really hasn't been any research on needle insertion techniques.

And Dialysis Camp actually promotes rotating the needle once you get a flash back. Something many are saying you shouldn't do now that we have back eye needles. Something which I disagree with. Back eye needles up against the wall don't run well.

Too bad we couldn't have some real research into needle insertion.

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Specializes in haemodialysis.

I believe button hole needling is best especially for patients who self cannulate otherwise i have been told that the ladder one is the best thought I have just finished my renal course and my lecturer says button hole is the best. have a few articles about it will put it on line for you guys.

take care have just joined the forum how is everyone.

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