Getting the Needles In – Part 4 (Final)

Now, for the last, and probably the most useful step towards stress-free BigD:  buttonholing.  As I wrote in Part 2, the technique involves putting the needles into the same holes at the same angle every time you dialyse.

Start by finding two good sites for each needle (you should alternate between sites at each session).  I use each site for around six months, so make sure they are easy to access, don’t block blood flow, etc.

You’ll need to use sharp needles for the first seven or eight sessions to create the track, which is like a firm tube of flesh under the skin around the hole.  You can sometimes feel the track when you roll the tip of your finger over the puncture site.  Once it’s formed, it’s time to switch to blunt needles!

How to buttonhole: before you (or your nurse/helper) put the needles in, disinfect as usual (with an alcohol or Betadine swab), then use a sterile needle to pick off the scab that formed since the last cannulation.  (This is something that most of us enjoyed as kids, but has been programmed out of us by “Don’t pick your scabs!” from our parents.  The circle turns again, grasshopper.)  You need the scab off so that the needles side in easily, without any resistance (or pain!).  All other needling steps (taping, flushing, etc.) are the same.  It’s pretty simple.  I was going to make a nice How To video, when I found that Bill Peckham has already done one, so check it out.

Some of the good things I’ve found with buttonholing:

  • It is (mostly) painless, so while you don’t actually look forward to the BigD, you don’t dread it either
  • I have never had blows, scrapes or other dramas with blunt needles
  • Because blunt needles don’t dig, scrape or pierce, you get a lot more arm movement and flexibility (I type with both hands on the BigD)
  • The holes clot quite quickly when the needles come out, so less double taping and waiting to go
  • As far as no aneurysms (ballooning of the fistula), it’s a bit late for me, but add it to your list.

Bad things:

  • Scab removal requires a couple of minutes more preparation time
  • er, hmm.  Can’t think of much else (maybe you can?).

Finally, as I have said several times before, you get best results if you needle yourself.

Next post:  Keeping your brain sharp while on the BigD regime.

2 thoughts on “Getting the Needles In – Part 4 (Final)

  1. Well done Greg, so simply put, button holing is the way to go. Not everyone can take the next step but other Big D customers should take a read of this and take the plunge.


  2. Greg,

    Since you encouraged me to buttonhole I have never looked back. I maybe anal retentive but being able to take control of the situation is important to me. Button holing for me has taken the stress out of canulating. There is next to no pain and the needle just slips in. My fistula is check regularly by a renal specialist and has not given me any trouble. For me one of the most important aspects of preparing my fistula is the use of betadine to ensure the sites are properly disinfected. Thanks for your advice and encouragement.


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