Self-cannulating and buttonholes

Onekidneynurse · Jan 8, 2010

RE: self-cannulation: What do we think about it? Do you teach it only with intentions of home HD? Do you encourage the able-handed to give it a try?
RE: buttonholes: how often do they give out and force the need for a new buttonhole? Do you use the tweezers or the little tips on the needlecap to pry off the scab? What if you come across a buttonhole site that, every single day, is SO hard to push through "on the inside"?
I've just transferred to my FA's other clinic and it is like night and day. I'm so much happier than I was at the first one! BUt anyway, we've got so many buttonholes and I love it! The LVN that used to be charge at this clinic established all the fabulous BHs, many of them still in use today. I am having trouble with 2 of them. The first one feels like it is never going to get through to the vessel! You know, the needle is maybe a third in and should be flashing back by now, but you just hit this resistance! Then finally it gives, you were afraid you'd plunge the needle all the way through to the other side! Anyways, any ideas? The venous is great! This pt. kept suggesting that she would try to stick herself some time soon and we kept encouraging her. Finally yesterday she did it! We did the arterial, (that is the really tough one) and she popped the venous one right in! We all cheered and clapped for her, it was great! I think it gave her another level of connection with the treatment, so to speak.
The second BH I have trouble with seems to get lost between treatments. m This is a well-established one, but the pt is very prone to scratching at her arms. When i first came, I had to avoid the venous one because it seemed to have a pus-filled blister over it (which popped and dried up over the weekend) Other times, there is just no evidence of the location due to a skin condition which leaves her scaly and dry all over. Some days it is there, plain as day. On the "off" days I go away from the area, but she has such a short fistula. Her arms are very stout and chubby-wrinkly.
Give me some wisdom, BH-ers!

Although BH's have been around for years in Europe we've stopped creating them due to infection issues. Patient's were taking the scabs off with their fistula needles and then inserting that same needle. I don't think they are faster. I hate digging off those scabs. I can cannulate quicker.

I believe it's difficult to create them because the same sticker isn't there for the 2-2 weeks they need to be created. Besides I don't believe I go in at the same angle every time. Just like cooking sometimes it tastes great and other times not so good even with the same method and ingredients each time.

I encountered a drug user in PA who used his fistula for illegal IV drugs. Got MRSA in his fistula. Had to band it off and go back to a tunneled cath. I'm sure he's using that. Another patient there was using her's. She wouldn't let us put anything over the end caps or the pinch clamps. She didn't want to have to bother with removing it when she needed her fixed. Both situations were admitted to by the patient.

In Tempe AZ we were informed by the CM that we had to remove needles from patients wanting to go to the BR and reinsert when they came back. She was so worried they would take drugs in the BR. I never did find out what we were suppoded to do about catheter patients using the BR. We never removed their catheters. LOL:idea:

GeauxNursing · Jan 10, 2010

I don't think they are faster. I hate digging off those scabs. I can cannulate quicker.

This is true, but it's not like we use BHs only because they are quicker for us. We use them because they prolong the AVF's life, right? It's for the pt benefit, not just for us to get them on quicker. (But I know you didn't mean it that way : )

In Tempe AZ we were informed by the CM that we had to remove needles from patients wanting to go to the BR and reinsert when they came back. She was so worried they would take drugs in the BR. I never did find out what we were suppoded to do about catheter patients using the BR. We never removed their catheters. LOL:idea:

Wow, really? That is just crazy!! Did ppl actually consent to this? I mean, wow. I know the FMC I work at PRN has a "bathroom privilege" AMA that they use. My Davita does not have any such document.

Onekidneynurse · Jan 10, 2010

This is true, but it's not like we use BHs only because they are quicker for us. We use them because they prolong the AVF's life, right? It's for the pt benefit, not just for us to get them on quicker. (But I know you didn't mean it that way : )
Wow, really? That is just crazy!! Did ppl actually consent to this? I mean, wow. I know the FMC I work at PRN has a "bathroom privilege" AMA that they use. My Davita does not have any such document.

Our patients are very impatient. They don't want to wait at all. LOL

Tempe had a BR AMA and I tried to convince the CM that covered us but she wouldn't hear of it. But then that's the beauty of travel nursing.

Trauma Columnist · Jan 10, 2010

I like BH, but I stronglyy encourage pts to self-stick. Doesn't necessarily mean they are going to be home pts, just that they are taking more responsibility for their own care - which helps everyone!

Tish88 · Jan 25, 2010

I support button holes too. I have the patients create their own, that way you don't have to deal with staffing issues.

This is done with my incenter and home patients.

I also have them make a secondary set of BH's and have them rotate them. I do this just in case there is an issue with one of their holes, they always have a back up and never miss a treatment because they can't get a needle in.

Valerie Salva, BSN, RN · Jan 27, 2010

I support button holes too. I have the patients create their own, that way you don't have to deal with staffing issues.
This is done with my incenter and home patients.
I also have them make a secondary set of BH's and have them rotate them. I do this just in case there is an issue with one of their holes, they always have a back up and never miss a treatment because they can't get a needle in.

Good ideas!

I have rarely come across buttonholes. I wish more centers would be open to them.

Natkat, BSN, MSN, RN · Jan 29, 2010

It seems like they go back and forth with BH. I understand they were quite popular a long time ago, but then they stopped doing them so much. Now I'm seeing them more and more often so it appears they are encouraging their use again. I like them. I find them so much easier to cannulate. As for patients cannulating themselves, I encourage them to. It goes a lot faster for both of us, and patients who do this are adept at finding the best "spot" to cannulate. It makes me feel better knowing that might hurt them or infiltrate them. My cannulation skills aren't the best, so for me it's a relief if the patient does it themselves.