Home hemodialysis

The buttonhole technique for home hemodialysis

Mary Showers, R.N., B.S.N., C.N.N.

Home hemodialysis (HHD) requires that patients or their care partners insert dialysis needles into the patient’s vascular access. The needles allow the patient’s blood to flow from his or her body through a dialysis machine to be cleaned and back into the body. Most HHD patients insert their needles themselves. This is called self-cannulation.

Home hemodialysis (HHD) patients are trained to self-cannulate when they go through their home training program. Care partners are also trained to insert the dialysis needles. While many patients may seem overwhelmed at the thought of self-cannulation in the beginning, most learn that it’s not hard to do and actually prefer inserting their own needles after they are trained.

There are a few different methods patients can use to self-cannulate. One of the easiest and most comfortable methods is the buttonhole technique.

Overview of the buttonhole technique

The buttonhole technique is a self-cannulation method which requires patients to insert their dialysis needles into the same spot each time they do dialysis. This causes scar tissue to form at the insertion point and creates a hole similar to the hole in a pierced ear. It generally takes three to four weeks for the hole to be created. Once the hole has formed, patients can use blunt dialysis needles instead of sharp ones. Blunt dialysis needles are more comfortable and safer to use.

Requirements for the buttonhole technique

To do the buttonhole technique, patients must have an arteriovenous (AV) fistula as their vascular access. An AV fistula is created by connecting an artery to a vein. During the operation, a surgeon will create a small opening in the side of one of the patient’s arteries. The surgeon will then dividone of the patient’s veins and sew it to the opening in the artery. AV fistulas do not require a man-made connector to attach an artery to a vein. Because of this, once an AV fistula matures, it becomes a natural part of the patient’s body.

In addition to fistulas being required for the buttonhole technique, fistulas are also the preferred type of vascular access for all hemodialysis patients. This is because they provide good blood flow and generally last longer than other types of vascular access.

Fistulas can take from three to six months to mature so it is important to talk to your doctor about fistula surgery well before you need to begin dialysis. After your operation, you can strengthen your fistula by doing exercises such as squeezing a rubber ball.

Benefits of the buttonhole technique

The three main advantages to using the buttonhole technique are:

• Decreased pain: Because patients are inserting blunt needles into a hole created by scar tissue, insertion is much more comfortable.
• Less time consuming: The buttonhole technique is less time consuming because patients are inserting needles into the same spot every time they dialyze, instead of locating new spots to cannulate. The blunt needles used with the buttonhole technique slide in easily, which greatly reduces the time needed to self-cannulate.
• Fewer complications: With the buttonhole technique, there are fewer complications such as hematoma formation (bruises), needle reinsertions, aneurysm formation (a bulge in a blood vessel) and infections.

Summary

The buttonhole technique is changing the way many patients feel about self-cannulation and at-home dialysis. If you are interested in a self-cannulation method that is not only easy, but more comfortable, talk to your doctor today about the buttonhole technique.

About Mary Showers

Mary Showers, R.N., B.S.N., C.N.N., is the National Director of Outcomes and Quality Management for DaVita at Home.

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• Overview of self-cannulation for home hemodialysis