Re: buttonhole cannulation with regular 15g needle?
The above poster is correct; and just to clarify, the initial advice you were given regarding using a sharp fistula needle AWAY from the buttonhole is the appropriate course of action if you aren't equipped to access the buttonhole.
The buttonhole is a tract created by the same tech cannulating the same site on the access for about two weeks, at which point the tissues heal much like an ear piercing - once it's established, any experienced cannulator can access the buttonhole with a blunt needle (after carefully removing ALL of the scab from the site).
Imagine stabbing through a piercing with a sharp needle... if your needle doesn't go exactly through the hole already created; the subsequent tissue repair where your sharp needle pierced the tract of the piercing may cause scarring and ultimately ruin your piercing - or in this case, the pt's buttonhole.
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