Cannulation sites

Since the button hole sites are so big, i'd advise the director of the clinic. Yes, I know that the site is button hole and the site should always be stuck in the same place bc there is a tunnel that has been developed for that pt, by sticking elsewhere I would be hesistant as well. i'd just cover my own butt and advise a superior b4 I did anything or since you stated the pts are seasonal hence they are transient pts, call their regular clinic and tell them the problem. With such large sites, it could open the door for problems. When in doubt, ask.

Thanks for your response, keep in mind these are Not buttonholes is my point. His home clinic uses the same site/hole each time with regular cannulation needles. Same site cannulation, not buttonholes. When I first assessed him when he arrived in town and stopped in to sign his paperwork I noticed they are large with one and only one spot of cannulation, so asked him if these were buttonholes. He responded yes and not to use sharp needles. In contacting his home clinic, they said no and not to attempt buttonhole needles. He is regular cannulation but same procedure as buttonholes? This is just something else new to me I havent experienced. I do buttonholes so that's not the issue. I know what the medical director will say, Put it any where he wants it rather than consider what may be the best choice or not. Tends to like to keep them happy and quiet by agreeing with them. I cant find anything in our policy with same site cannulation related to non-buttonhole. They appear as if they are developing significant signs of becoming aneurysm. Myself, non-buttonhole I would be ladder or rotating sites so need some opinions. Trying to explain anything to my administrator (who is in another city) over the phone doesnt work to well, and becomes much more drawn out then need be so I dont even bother to call her unless I have no other alternative. I'm a new DON at this clinic, so I have to also listen to everything else within the same call so to speak lol.

Okay, i was a bit confused when you mentioned the button hole technique, but yet he does NOT have an access set up for buttonhole? In that case, do not stick the same spot over and over again. It will make it harder for him to clot at the end of tx, and I do not feel he would be getting the quality dialysis that he deserves. As for his prior clinic, they claim they stick the same site even though he is not buttonhole? That to me makes absolutely no sense. If it were me if would suggest the ladder rope technique to your pt. stating that he will have a better tx and that it is not good for his access to be stuck in the same place over and over again. But you also need to keep in mind that the pt. primarily has the last say in this. Perhaps he has had alot of bad experiences with cannulations and he feels comfortable with the same site cannulation. It is our position to provide the pts with the best tx possible and keep our pts informed. There is no sense in getting into a tiffy with a pt over where to stick him if that is where is insist on being stuck. Just inform him of the consequences and if you are able to, it wouldn't hurt to contact his neph. and let him know what is going on. Good Luck to You.

My Unit carried out a buttonhole trial about 18 months ago. During this time we found that with a couple of patients we never reached a point where we could use blunt needles for cannulation and instead had to continue with regular needles. Apart from this these buttonhole sites caused no problems.

This however doesn't explain why your patients access sites are so large. The most likely reason that I can think of is that the staff haven't being cannulating in exactly the same place and this has lead to a merging of numerous puncture sites, as opposed to one true buttonhole site.

Puncturing the same site over and over causes pseudoaneurysms which can, if large enough, rupture, from my understanding. This occurs when staff stick the same area/site over and over. I have been told by some techs that it is easier for them, however, they should have been taught it is not ok. Doing the 'rope ladder' technique can prevent aneurysms, however, the puncture sites are still close but going up one side of fistula then the other is the best way if the patient is not a candiate for buttonhole. RenalRuth