Dialysis and the ins and outs of buttonholing

Do you know the Nine Inch Nails’ song “Hurt” sung by Johnny Cash?  It is a very moving and disturbing song about the effect on drugs on the singer.  All of us BigD members can especially relate to the first few lines:

I hurt myself today
to see if I still feel
I focus on the pain
the only thing that’s real
the needle tears a hole
the old familiar sting
try to kill it all away
but I remember everything

For the BigD, especially when we’re new to it, the needles loom large.  But they need not.  One of the ways you can cut needling down to size is buttonholing.

What is buttonholing? For dialysis, it has nothing to do with sewing machines, or grabbing someone’s attention.  It is a powerful technique for getting the needles into your fistula with minimum pain and minimum damage.  I have written about it several times in earlier posts, but it is worth revisiting.

Chris, our unit manager is on sick leave, and we have been fortunate to have the country’s foremost experts in buttonholing, Anna Flynn fill in for her.  Anna and her colleague Annette Linton presented a slide show on buttonholing to the Renal Society of Australia in 2008.  It showed the what, why, when, where, who and how of buttonholing, and was so successful that it has become a key buttonhole teaching aid for both renal staff and for we members of the BigD club.

Anna and Annette’s presentation has some great shots of what the buttonhole track looks like in the fistula wall, as well as some quite graphic ultrasound images (fortunately in black and white, so not too gruesome).  Check it out:

Basically, buttonholing is inserting the needles into your fistula in the same spots, at the same angles every session.  The needles gradually wear a track through the skin and through the fistula wall.  After about two weeks, the track is so clear that you can switch from sharp to blunt needles, and it can become almost painless.

Buttonholing is not new.  I started using it about 12 years ago, after reading about its success in Europe and having it recommended by the then unit manager, Anna.  I must say I hesitated. To me it was counterintuitive to constantly use the same holes.  How would it ever close over and repair itself? Maybe it would pop open if I lifted something heavy?  What about in the shower or swimming, maybe I would wash off the scab and open the hole.  They seemed like reasonable fears to me.

But it clearly didn’t work that way for others, so I gave it a try.

I soon found that the body doesn’t work like that.  It seems to get used to the needles and, like with other parts of the body, creates the equivalent of a callous, or thick scar tissue to form a track into the fistula.  Since the track is usually less sensitive, there is less pain.  Also, the track closes quickly once the needle is removed and a little pressure applied, so bleeding stops within a few minutes.

I especially like using blunt needles – there is no chance of a blowout, they are just not sharp enough to push a new hole through the fistula wall.  In fact, unless to pick off each scab before you insert the needles, they won’t even go in.

Buttonholing works best when you do it yourself.  While sticking needles into yourself sounds a little outrageous, it’s not especially difficult.  The first time is the toughest. Ask someone you know needles well to talk you through it, and then take plunge.  You’ll get better and better as time progresses.  DIY also eliminates the stress of wondering if the person needling you will make a mistake.  You won’t make a mistake, because you can feel exactly where the needle is going.

So, you may still hurt yourself today getting those needles in, but with buttonholing, it’ll only hurt only a little.

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