The Buttonhole Technique for Home Hemodialysis

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

Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician.

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 an artificial kidney, the dialyzer that's attached to a dialysis machine, to be cleaned and back into the body. Most HHD patients insert their needles themselves. This is called self-cannulation.

HHD patients are trained to self-cannulate during 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.

Patients can use different methods 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 tunnel, or 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. A vascular access surgeon constructs an AV fistula by creating an internal connection between an artery and a vein. Because a man-made connector is not used, the AV fistula becomes a natural part of the patient’s body as it matures.

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 and aneurysm formation (a bulge in a blood vessel). The risk for infection with the buttonhole technique is low; however, infections can be serious and cause a widespread blood infection. To prevent infections, follow the cannulation procedure exactly as it's taught during training.


The buttonhole technique is changing the way many patients feel about self-cannulation and 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 techniques.