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.
- 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.