Suggestions to avoid problems with Buttonhole for CKD Population


The buttonhole technique is another way to insert needles into your arteriovenous (AV) fistula. It requires putting the needles into the exact spot at the same depth every time your needle is inserted. There are dialysis patients who have been using this technique for over twenty years with the same fistula. This technique is only for use with AV fistulas not AV grafts.

Research has shown that when using the buttonhole technique there are fewer cases of swelling from the dialysis needle going through the fistula wall (infiltrations), reduced misses when attempting to place needles, and less pain when the needles are inserted. If you are currently or are considering using the buttonhole technique, here are some suggestions to help you better manage the process.

Infection Control - recent findings indicate that there is an increased risk of infection with buttonholing, so swab before and after removing the scab, and if you need to fully withdraw the needle while you are hunting for the flap, start again with a new needle.

Removing Scab - to get the scab off before inserting the blunt needle it may be beneficial to use a sharp needle, so you can get under the scab and lift it off.  Most people use blunt Drawing-Up needles.  Both are effective; the sharp appears to be quicker, but you can do a bit of damage if you are not careful. Also if you are having trouble getting the scab off, put some saline or skin disinfectant on some gauze for 5 minutes, to soften it up.

Inserting the Needle - sometimes with the best technique your needle will not easily find the entry flap. Do not force it because you can tear and scrape tissue which is both painful and ineffective. Insert the blunt needle by holding the tubing part of the needle just behind the wings and with a gentle twisting and rotating motion, allow it to seek out the tunnel.  It can be helped along by gently stretching the skin to open the tunnel. recommends using the same needle-holes during each dialysis session (buttonholing) because on a day-to-day basis you suffer less pain as needles go in, less lumps and bumps develop on your arm, and your fistula will remain functional longer. Check with your Neohrologist or dialysis nurse to see if this technique would work for your particular access. 

Reference: "Dialysis Buttons for Your Buttonholes." Big D and Me.

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