My experience with buttonholes

The buttonhole method is widely acclaimed as 'the thing' for daily dialysis whether short or nocturnal. The needles that are used generally for dialysis have sharp ends so that they can make their way through the tissue and reach the artery or the vein.

The downside to using them is that there is pain during insertion and often during dialysis because of the sharp ends. A little Xylocaine is often used to reduce the pain. Also, a different pair of sites for the arterial and the venous accesses is used for each dialysis session. This is called the step ladder method.

In the buttonhole method, blunt needles are used instead. For the first 4 or 5 days, sharp needles are used at the same pair of sites. This makes a 'tunnel' at the two sites. From the next day, blunt needles are used. Since there is already a tunnel in place, the blunt needles go in easily and you don't actually need sharps.

This is less painful and also safer since if you're dialysing at night, like I do, there is a possibility of moving your arms and sometimes the needles may move so much that if they have sharp ends, they might actually pierce the walls of the artery or vein and cause bleeding. This is rare, of course, but nevertheless, a possibility.

I started using buttonholes a little less than three years back. To start with, things were really excellent. At that time, the tech who initiated my dialysis would do the cannulation. There was absolutely no pain. I remember making a comment to my vascular surgeon, Dr. P. C. Gupta that if I turned the other way while the tech was doing the cannulation, I wouldn't even know when the needle was inserted!

After a few months however, there was pain during cannulation. I had to start using Xylocaine. But I noticed that after using Xylocaine for a couple of weeks, I did not need to use it. But again, after a few weeks of not using it, I would need to use it!

I then changed the location of my buttonholes and found that the pain was much less. So, I am quite confused about the whole buttonhole methodology.

I have only seen one person on the home dialysis forums saying that she needed to use an anesthetic like Xylocaine inspite of using buttonholes. I was quite relieved to see that post actually because I was wondering why I seemed to have pain while others were so happy with this technique.

Each individual's body is different and what works for one may not necessarily work for another. I am still using buttonholes but I'm really wondering if I should switch to sharps. Especially since I need to get the buttonhole needles from the US. They are not available in India.

Again, I am not sure. I have used sharps only on a few occasions in the last three years. Maybe the possible risks are higher. Buttonholes have shown to improve the life of a fistula. I don't want to take any chances. So, maybe I will continue to use them for some more time.