Buttonholing

[GeauxNursing]

Who is having great success with their buttonholes? Are you able to have the SAME sticker there every day to ensure the same insertion point, angle, etc? We start them off until the tunnel is established, then the pt takes over.

We only had one successful go at this whole "project." The pt went on to home hemo. But the other ones we tried, the technique never worked, and now we have nothing to show for all the education we received on buttonholing. It's kind of frustrating.

For my clinic, the few pts we did try to start on this just never took to it. They didn't want to move on to the blunts, the cannulation hurt worse, they still needed lido, and the tunnels were just not, well, successful.

how is everyone else getting along?

[traumaRUs, MSN, APRN]

I'm an advanced practice nurse and do the rounding on 200 chronic HD pts. We choose our pts for buttonholing pretty carefully. We want them to be compliant, able to physically stick themselves and have an access that is pretty new and/or in very good shape. Yes, we do try to have the same sticker for the first 2-3 weeks. Then....and we always make this very clear in the beginning, the pt takes over. We have had pretty good success.

[jnette, ASN, EMT-I]

Our medcal director/nephrologist would not approve the buttonholing technique.

I'm glad, too. We never heard much good about this technique from other sources.

[momRNof3]

I do understand if you can't have the same person cannulate the development of the buttonhole is difficult to achieve. I run a small clinic with 30 pt and have only 7 fistulas but all are buttonhole. I developed most of them. I would come in on my day off just to stick them. I have a new fistula in the unit and have chosen a dedicated RN to cannulate. If she isn't working then the patient doesn't get stuck. We have had only one infiltrate since using this technique and the patients we have are all using 14g buttonholes now. The patients in our unit much prefer this technique now that the holes are developed. There are a few "tricks" to easing the needles in. I just wanted to post that we have had success and another unit in our group has done the same with great results. Please research more. I think this technique is extremely beneficial to the patient.

[kmcourt66]

we have many successful buttonholed patients in our unit. we always have the same RN or tech establish the button hole usual takes about 3 - 6 cannulations/treatments then once established anyone can cannulate. i encourage my patients to learn about buttonholes see if they are interested. if the RN or tech who is establishing is off then the button hole is not used unless established and using blunt needles.

[AmyLiz]

I work for a large clinic (24 chairs, total of around 150 patients). We have several buttonholes that are just fantastic...really easy to pop those needles in. Others...well, we had to give up on because they would just NEVER establish the tunnel! Then you get the odd pt who gets a nice established buttonhole & then something weird happens & the AVF shifts or something & you can't find the tunnel anymore (which happened to one of my patients a few weeks ago...the arterial buttonhole is still there & great, but the venous is no where to be found, so I have to re-establish that one. )

Sometimes I wish we hadn't started the whole buttonhole thing...there are several patients that I had never had trouble sticking with regular sharp needles, but now that they're buttonholed, I can't get the darn needle in the AVF...due to the angle or whatever that the establishing cannulator used. Other times, it's great. Kind of a hit or miss thing.