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Buttonhole dialysis

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 Stuart Mott, LPN, is a pioneer in buttonhole cannulation, whose articles about Touch Cannulation, Cushion Cannulation, and Tandem Hand cannulation have changed practice. His approach to cleaning buttonholes more safely to improve infection control has now been used for 54,094 cannulation in four countries without a single infection. Stuart is currently working as an acute dialysis nurse in St.

The Buttonhole Technique for Home Hemodialysis - DaVit

  1. In the case of a fistula access center, the buttonhole technique can be used when inserting dialysis needles
  2. The buttonhole technique makes it easier for dialysis patients to perform self-cannulation, especially those who perform dialysis in the comfort of their own homes. This cannulation technique is also found to be less painful than other techniques because the buttonhole technique allows patients to use a blunt needle
  3. Dialysis Needles, Self-Cannulation and the Buttonhole Technique For many people on in-center hemodialysis (HD), getting the needles placed is the most high stress part of a treatment. Lack of control over who puts in your needles can be a black cloud over your treatment days

Buttonhole Technique - Home Dialysis Centra

For patients doing home dialysis, especially with self-cannulation, the buttonhole makes sense. Strict adherence to the steps outlined in our procedure has proven to be effective in preventing the occurrence of access-related infections The buttonhole technique is recommended for those who self-cannulate either in the hemodialysis center or when performing home hemodialysis. After about 10 cannulations using sharp dialysis needles, the buttonhole site will develop a scar tunnel track. This track is the same as a pierced ear that has scar tissue formed and will cause less to no. the uptake of buttonhole technique and increase understanding to mitigate associated risk. I would like to congratulate the faculty, ably led by Katie Fielding and Mick Kumwenda, both on the content of the guidance and also producing a true multi-professional document. Chair, Clinical Reference Group (Dialysis), NHS Engaln Buttonhole cannulation is associated with a higher risk for vascular access-related infection than rope-ladder cannulation in patients on in-center hemodialysis, according to a published study Vascular access Cannulating (puncturing your Ateriovenous Venous Fistula) is among the more difficult aspects of Hemodialysis (HD). However, many patients have discovered that the Buttonhole Technique (using dull needles) can make AV Fistula cannulation more bearable and less painful

The Buttonhole Technique Helps Give Patients on Dialysis

Cannulation of an AVF is by one of two different methods, stepladder or buttonhole (8, 9). The needle insertion sites are changed for each hemodialysis treatment in the former, but kept constant in the latter, resulting in the formation of a fibrous tract ButtonHole cannulation is the practice of cannulating an AV fistula by going into the exact same spot repeatedly with a dull needle. ButtonHole cannulation is the practice of cannulating an AV fistula by going into the exact same spot repeatedly with a dull needle buttonhole AVF cannulation technique was widely pro-moted by the Fistula First Breakthrough Initiative in its first few years.3 However, more recent studies from the past decade have tempered enthusiasm for the buttonhole technique. After each dialysis session, a scab forms over the buttonhole exit site. This scab is frequently colonized wit KANSAS CITY, Mo. — The buttonhole technique for vascular access is safe for home hemodialysis as long as patients are diligent about skin preparation and cannulation, clinicians from Fresenius..

What is the Buttonhole Technique and Why is it Useful in

ButtonHole Video | NxStage Medical Inc. ButtonHole technique cannulates an AV fistula by sliding the needle into the exact same place repeatedly and has been used world-wide for over 35 years. ButtonHole technique cannulates an AV fistula by sliding the needle into the exact same place repeatedly and has been used world-wide for over 35 years are unfamiliar with the Buttonhole Technique. • If your patient is hospitalized, having a procedure, or traveling and the professional does not know how to access a buttonhole, tell them to rotate sites using sharp needles, staying ¾ of an inch away from the front of the buttonhole tunnels. Buttonhole opening ¾ Hospitalizations. The buttonhole cannulation technique purportedly reduces the risk for needle infiltrations of the AVF by creating subcutaneous channels from the skin to the AVF lumen, thereby providing a road map for repeated cannulation Step by step instructions on how to buttonhole a fistula from York Renal Uni The cannulation technique of a hemodialysis vascular access has remained controversial with differing viewpoints. The quality of dialysis, overall patient safety, and individual dialysis experience often dictate the type of cannulation technique used in clinical practice. The three commonly used techniques to access a hemodialysis vascular access are the rope ladder, area, and buttonhole

Dialysis Needles, Self-Cannulation and the Buttonhole

Buttonhole Access for Hemodialysis: Right for Some

Instructional video on the proper use of the Nipro BioHole Dull Needle for the Buttonhole technique Original Investigation Buttonhole Versus Rope-Ladder Cannulation of Arteriovenous Fistulas for Hemodialysis: A Systematic Review Ben Wong, MD,1 Maliha Muneer, BSc,2 Natasha Wiebe, MMath,2 Dale Storie, MA,2 Sabin Shurraw, MD,1 Neesh Pannu, MD,1 Scott Klarenbach, MD,1 Alexa Grudzinski, BSc,3 Gihad Nesrallah, MD,3 and Robert P. Pauly, MD1 Background: The buttonhole technique is an alternative. Suche Bei Uns Nach Dialyse. Sofort Ergebniss Buttonhole cannulation in adult patients on hemodialysis: an increased risk of infection? Birchenough E(1), Moore C, Stevens K, Stewart S. Author information: (1)Renal Care of Northern New York, Watertown, NY, USA. birchene@upstate.ed Diacan Buttonhole. Buttonhole cannulation is a fistula-saving cannulation technique which allows access to a patient's fistula through the exact same puncture point with every treatment. Instead of using regular sharp fistula needles, specific blunt needles are used to gain patient access, which provides a comfortable and convenient insertion

Background and objectives: Buttonhole (constant-site) cannulation (BHC) continues to gain popularity with home and in-center dialysis programs worldwide. However, long-term safety data are lacking. This paper reports the authors' single-center experience with Staphylococcus aureus bacteremia (SAB) and the efficacy of topical mupirocin prophylaxis (MP) LHF had 109 patients receiving hemodialysis. Of these, 83 had AVFs; 52 used 2 buttonholes for cannulation, while 1 patient used 1 buttonhole site in combination with the rope-ladder technique. No patients had more than 2 active buttonholes. Patients received dialysis on average 3 times a week Dialysis needles, self-cannulation, and the Buttonhole technique For many people on in-center hemodialysis (HD), getting the needles placed is the most high stress part of a treatment. Lack of control over who puts in your needles can be a black cloud over your treatment days maintenance hemodialysis patients • Patients randomized to a 1-year intervention of buttonhole (constant site) or usual-practice (different site) cannulation • Primary and secondary outcomes •Primary study outcome was AVF survival over 1 year, in which AVF failure was defined as an AVF no longer used for hemodialysis (also referred to as. Buttonhole® with Steripick™ Repeated cannulation of the same site (constant-site technique) has been used worldwide to cannulate native AV fistulas in hemodialysis for over 25 years. Reported benefits of ButtonHole include: Less discomfort in cannulation for both patients and staff; Reductions in incidence of hematoma and risk of thrombosi

08-13-2008, 04:22 PM. Establishing New Buttonholes. We eventually discovered that actually the fistula vein (which is still fairly new) had matured more, dilated and risen somewhat closer to the skin surface. So, every time I stuck the buttonhole at the original angle/path, I was infiltrating Bioholes ® were developed in Japan in 2003 (yes, things move slowly in medical world), to speed the buttonhole development cycle and the enable the buttonholing to be introduced to dialysis units on a large scale. The problem with the buttonhole approach is that it requires that the same person to insert the needle each time. This is not possible in most dialysis units with many staff on. Rotation of cannulation sites should be observed in these grafts; however, constant cannulation (buttonhole) has not been studied. 244 Dialysis Catheters and Port Catheter Systems (CPG 3.5) A dislodged (cuff exposed) or potentially infected catheter or exit site requires further assessment and possibly an intervention before being deemed safe.

The next day my dialysis nurse came to my house and assisted me in using a sharp needle to attempt to start a new buttonhole above my current venus access site. I have a small fistula area, so we had very little room to place a new needle. We were successful two days, but on the following Wednesday I was again unable to run The first patient in whom the buttonhole method was attempted, in 1973, continued to use this technique for 26 years, and some home hemodialysis patients have used the method for 10 or 20 years. 3.

Rope Ladder and Constant Site or Buttonhole Techniques

clampcath buttonhole creation: complication of catheter breakage. Hemodial Int. 2013;17:450-454. 22. MacRae JM, Tai DJ, Daniw M, et al. A simple method to create buttonhole cannulation tracks in a busy hemodialysis unit. Hemodial Int. 2010;14:94-95. 23. Letachowicz K, Kusztal M, Golebiowski T, et al. Use of plasti The most common reason for declining to participate was a strong preference for a particular cannulation technique (33%). Patients randomized to buttonhole versus stepladder cannulation required a shorter time to complete home hemodialysis training. We did not observe a reduction in cannulation pain or complications with the buttonhole method Dialysis units with a low infection rate may continue to use the buttonhole technique, as the risk of complications is lower. The four cannulation techniques, rope ladder (RL), area puncture (AP), buttonhole with blunt needles (BHb), and buttonhole with sharp needles (BHs), affects the arteriovenous fistula (AVF) in different ways

Hemodialysis patients with an arteriovenous fistula can use buttonhole techniques for cannulation. Although buttonholes generally work well, patients may report difficult and painful cannulation, and buttonholes may fail over time. We aimed to assess the effectiveness of tract dilation in treatment of failing buttonholes BACKGROUND: The buttonhole technique is an alternative method of cannulating the arteriovenous fistula (AVF) in hemodialysis (HD), frequently used for home HD patients. However, the balance of risks and benefits of the buttonhole compared with the rope-ladder technique is uncertain Use sterile gauze to put a small amount of antibiotic cream/ointment or antimicrobial impregnated gauze over the buttonhole sites. OR. Cover the buttonhole sites with sterile gauze or antimicrobial impregnated gauze. Do NOT use Gelfoam® or Surgicel® after dialysis. Tape over the buttonhole site and leave dry dressing for 12 - 24 hours

Buttonhole cannulation associated with higher risk for

Buttonhole cannulation is ideal for such accesses, but the technique for creation provides major challenges. In 12 patients, buttonhole tunnel tracks were created by leaving the polyurethane catheter of a Clampcath ® hemodialysis needle indwelling for 10 days after the initial cannulation. After each dialysis the catheter was flushed, and. During dialysis, your blood will flow through a special filter that removes waste and excess fluid. The filter is sometimes called an artificial kidney. The same site is used every time, and over time, a small tunnel will form in the skin. This is called a buttonhole, and it is like the hole that forms in a pierced ear. Once this forms, you. Buttonhole needling of hemodialysis arteriovenous fistulae results in less complications and interventions compared to the rope-ladder technique. Nephrology Dialysis Transplant, 1-6.<br />Twardowski, Z.J. (1995). Constant site (buttonhole) method of needle insertion for hemodialysis. Dialysis & Transplantation, 24(10), 559- 576.<br />Twardowski.

Should Buttonhole Technique In Chronic Kidney Disease

Sukthinthai N. Buttonhole technique better than area puncture technique on hemostasis and pain associated with needle cannulation; J. Med. Assoc. Thai. 2012; Kim MK. Clinical effects of buttonhole cannulation method on hemodialysis patients, Hemodial. Int. 201 Vascular Access for Hemodialysis. Hemodialysis (HD) takes some wastes and water out of your blood. Your lifeline on HD is a vascular access. An access is a way to reach your blood to clean it. There are three types of vascular access for HD: An arteriovenous (AV) fistula. A surgeon links an artery to a vein under the skin of your arm The buttonhole method has been associated with ACKNOWLEDGEMENTS high risk of infection.12-14 Bacteremia rates of the The authors acknowledge the assistance of the nurses on the buttonhole technique have been reported to range dialysis units at the Royal Berkshire National Health Service Foundation Trust. from 0.15-0.6 per 1,000 patient-days, or. A dialysis fistula bruit (pronounced broo-ee), also called a vascular murmur, is an important sound and indicator of how well your dialysis access is functioning.. Hemodialysis requires access to your blood vessels. An arteriovenous fistula or AV fistula is one access type that is created by connecting an artery to a vein under the skin, usually in the upper or lower arm

Buttonhole versus Stepladder Cannulation for Home Hemodialysi

Aneurysms are less likely to develop if your needle sites are changed each dialysis (rope ladder) or if buttonhole needling is used. If the skin becomes thin and shiny in an aneurysmal area and you can see the fistula clearly pulsing under, the skin please notify your dialysis staff Objective In this study, we investigated whether there was any difference in pain and dialysis efficacy when patients who initially entered dialysis with the rope ladder technique were switched to the buttonhole technique. Methods We reduced the space between needles and examined the effects on access blood flow rate, dialysis efficacy, and pain levels with BH technique. Forty-four patients. DOI: 10.1093/NDT/GFM043 Corpus ID: 8175895. Cannulating in haemodialysis: rope-ladder or buttonhole technique? @article{Verhallen2007CannulatingIH, title={Cannulating in haemodialysis: rope-ladder or buttonhole technique?}, author={A. Verhallen and M. Kooistra and B. V. van Jaarsveld}, journal={Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant. Dialysis catheters are removed both during replacement and also when a patient receiving acute, shortterm therapy no longer - requires dialysis. There is no procedure code for removal of a non- tunneled central venous cathe ter, e.g., removal by pull after th e sutures are removed. An E/M office visit code can be billed as appropriate for the. Home Hemodialysis Buttonhole. 14.27 Posting Komentar. domestic hemodialysis amazon. Fasteners, mechanical components, mro elements, power additives. Taking care of your vascular access for hemodialysis. Read patient information from medlineplus taking care of your vascular get entry to for hemodialysis

ButtonHole AV Fistula Needles with SteriPick NxStag

to buttonhole or not to buttonhole that is the question? For many years the accepted method of cannulating an AV fistulas for hemodialysis has been the site rotation or rope ladder technique. Rotating needle sites was thought to prolong the life of the fistula and minimize aneurism formation The Bionic Buttonhole Needle combines the well known details of the Bionic Fistula Needle with the advantages of the buttonhole technique. Besides the known advantages of the Bionic Fistula Needles, for example the perfection of the bevel, the unique design of the Bionic hub, the silicone coating, the low flow resistance and the slit-shaped back Weiterlese

Fay now has very successful buttonholes She has had one episode of infection but as mentioned this was occuring pre buttoholing as well ; To evaluate the effectiveness of our buttonhole program we developed questionnaires similar to the Gold Coast presentation at RSA 2006. 13 clients and 9 staff undertook the questionnaire The tunnel track created with the buttonhole technique is often compared to the scar tissue that develops with a pierced ear. After the breakin period, patients were encouraged to use blunt cannulas. However, blunt cannulas were not available for single-needle dialysis (22 patients) and, therefore, could not be used The buttonhole technique involves repeated needle insertion in exactly the same site at exactly the same angle over several dialysis sessions until a track has been formed, after which a less sharp needle can be used to access the AVF via the preformed track

As Dialysis patients know, unsuccessful needling attempts can cause more pain and even infiltrations. 2.) Feel for the vein: Many Patient Care Technicians may feel that it is best to stick their Dialysis patients quickly to avoid pain and anxiety. However, they should take just one moment to feel for the direction of the AV Fistula vein in. Documenting Infection Rates and Buttonhole Practices for Pediatric AVF Cannulation. One key aspect of the Children's Mercy HD infection prevention strategy is greater use of arteriovenous fistulas (AVF) for dialysis access, and its successful use of the buttonhole cannulation technique

1 1 The Buttonhole Technique for AV Fistula Cannulation Lynda K. Ball, RN, MSN, CNN October 16 & 17, 2008 Trends in Nephrology Nursing Kaiser Permanente Acute Dialysis Symposiu tunnel tracks for buttonhole (BH) cannulation of AV fistulas (AVFs). This guideline applies to: • Self-cannulating patients (regardless of location of hemodialysis); and • Adults (over the age of 18 years). Buttonhole or constant-site cannulation is a cannulation method in which the AV fistula is cannulated in the exact same spot, at the sam

BACKGROUND Access to an adequate blood flow is a requirement for successful hemodialysis (HD). This often means repeated cannulation of an arteriovenous fistula (AVF), which can lead to damage that needs repair and revision. The Buttonhole (BH) method offers a successful cannulation with minimal damage. DESIGN A prospective cohort research study was initiated in two HD units in St. John's. The patient needs to be assessed as to whether they are a candidate for buttonhole needling by the senior dialysis nurse and the access nurse. 2.0 AIM/PURPOSE To give guidance to the multidisciplinary renal team for the referral and assessment of potential patients for the HHD and/or Minimal care programme at SaTH NHS Trust..

Home hemodialysis and buttonholes? Close. 3. Posted by 11 months ago. Archived. Home hemodialysis and buttonholes? My husband is 3 months in to home hemodialysis, and I'm having trouble with buttonhole cannulation. We had a couple of good sites, and for whatever reason we (I?) lost them. Now we're trying to establish new ones ButtonHole AVF Needle Sets with SteriPick® Needles and Syringes for Hemodialysis Renal Therapies -- Syringes and Needle During dialysis now it tends to leak blood around the edges of the button hole. It will stop if the needle is all the way in and pushed firmly against the buttonhole to plug the area shut. The hospital cannot tell me for sure what has caused this they just suggest we create another buttonhole Hemodialysis patients vaccinated against hepatitis B have a 70 percent lower risk for infection compared with non-vaccinated patients. Use of Buttonhole technique: The buttonhole technique to.

Rob's Nx Stage Dialysis nurse taught him this. Before set-up, place a thin layer of gauze on each buttonhole scab and douse with peroxide. The peroxide softens the scabs safely. He then will put a strip of tape over each section of gauze so that it will stay on and he can go about getting everything ready Experienced dialysis nurses have an 80% success rate identifying AVF maturity1 Nurses should look, listen, and feel the new AVF every dialysis treatment and document Report unusual findings to the nephrologist The Buttonhole Technique is anothe buttonhole sites. • Inspect your buttonhole sites and the skin around them daily. Contact your kidney doctor (nephrologist) or dialysis unit if: • There is redness, warmth or pain in the area of your buttonhole sites or on your fistula arm. • There is oozing or drainage from one of your buttonhole sites or your fistula The buttonhole technique of fistula cannulation popularized by Twardowski has been widely used for home hemodialysis. It involves using the same site for successive cannulations Arteriovenous fistula (AVF) is a life-line for hemodialysis patients. Complications associated with AVF cannulation including the occurrence of vessel stenosis and formation of false aneurysms can substantially shorten the length of AVF survival and its utilization. To minimize the damages to vessel walls of AVF, various needling techniques involving the utilization of sharp or blunt.

Hemodialysis patients' experience with and attitudes toward the buttonhole technique for arteriovenous fistula cannulation. Clin Nephrol 2010; 74:346. Nesrallah GE, Cuerden M, Wong JH, Pierratos A. Staphylococcus aureus bacteremia and buttonhole cannulation: long-term safety and efficacy of mupirocin prophylaxis The Buttonhole technique is a way of putting dialysis needles into the exact same spots every time to form tunnel tracts (like pierced earring holes). Once Buttonholes form, you can use blunt needles for dialysis, for less pain Buttonhole is a special cannulation method where an individual cannulates the AV fistula in the exact same spot, at the same angle and depth every treatment. The track is a tunnel that is created by the formation of scar tissue similar to the hole created in an earlobe for a pierced earring Dialysis Needle ButtonHole 16 Gauge 1 Inch ; Nipro Medical . MPN: FD+162530BC . Dialysis Needle ButtonHole 16 Gauge 1 Inch. In stock. SKU. NIP-FD+162530BC-BX/50. Be the first to review this product . Login - License Required. Add to Wish List Add to Compare. NEEDLE, BUTTON HOLE 16GX1 (50/BX 10BX/CS). Radiology (SIR) 2017 annual meeting, which assesses tract dilatation in dialysis patients whose buttonholes could no longer be cannulated.¹ Tract dilatation performed for 51 buttonholes Conclusion Buttonhole tract dilatation is a useful method to extend the life of failing buttonholes. For 9 patients with more than 1 encounter, the average tim

Buttonhole Versus Step Ladder Cannulation in High Dose Hemodialysis The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government Patients were trained according to usual home hemodialysis unit policies with the exception of the needle insertion protocol, in which a topical antiseptic to clean the AVF before needle insertion and the use of a topical antimicrobial cream to buttonhole sites after dialysis was mandated

AV Fistula Needle Buttonhole Fixed Wing Twin Pack 16gx1 With SteriPick 250/Ca 6666435 | Medisystems, A NxStage Co. — BH-2006PE This item can only be sold to licensed practitioner or any other person(s) or entity licensed by the State Background Buttonhole cannulation (BHC) has been associated with a greater risk of arteriovenous fistula (AVF)-related infections and septicemia than the rope ladder cannulation (RLC) in in-center hemodialysis (HD). Such infections have never been studied in satellite HD units. Study Design Retrospective single center study. Setting and Participant All patients in our satellite HD unit using a. The Buttonhole technique is a way of putting dialysis needles into the exact same spots each time to form tunnel tracts (like pierced earring holes). Once Buttonholes form, you can use blunt needles for dialysis, for less pain

A randomized trial comparing buttonhole to rope ladder needling among home hemodialysis or self-needled patients should be the focus for future research. a Southern Alberta Renal Program b Division of Nephrology, Department of Cardiac Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canad Arteriovenous fistula (AVF) is the preferred access for hemodialysis (HD). Buttonhole (BH) needling has increased following the introduction of blunt fistula needles. Although some reported advantages for BH needling, others have reported increased infection risk Collier et al (2016). Abstract: Arteriovenous fistula (AVF) is the preferred access for hemodialysis (HD) hemodialysis needle is put into the same spot to keep the tunnel open. When your dialysis treatment is done, a bandage is put over the site. This needs to be done 6 to 8 times and then the tunnel is ready. Why is a different kind of needle used when I have a buttonhole? After 6 to 8 treatments, the buttonhole is healed. Blunt needles ar securely tape the buttonhole needle set (figure 4) and proceed with the dialysis treatment per facility protocol. *note: ensure the same needle insertion angle and depth of penetration are used consistently for each cannulation of a constant-site

Home Dialysis Central - www.homedialysis.org 1 Background Dialysis needles are large and scary! Fear of needles and pain is a reality for most people on dialysis, especially in the beginning. Some have true phobia, and require special techniques and interventions to self-cannulate. All patients, once they become familiar with dialysis, worry. Harmony. The JMS Harmony Fistula Needle is for use with a previously-established mature access site using a constant-site (buttonhole) technique of needle insertion. This Fistula Needle is specially designed for home dialysis patients and patients that self-puncture doing home dialysis does not make you less likely to receive a transplant. If you do home dialysis, it costs more than at the dialysis unit. can use a buttonhole technique, which uses dull needles placed into the exact same hole every time you have dialysis. Ask your nurse to learn how. You must get rid of your pets to do dialysis at home

Buttonhole. Nipro's BioHole™ AVF or Catheter range are specialy designed to support the buttonhole technique. Using the buttonhole technique may cause fewer complications, compared to using different needle insertion sites for each haemodialysis treatment. Therefore, the BioHole™ AVF is recommended for home dialysis and self cannulation. In-center hemodialysis patients from 5 hemodialysis units in Denmark, dialyzed on a native arteriovenous fistula. 286 patients were included; 144 cannulated with the buttonhole technique. Exposure The buttonhole cannulation technique was compared to the stepladder or area puncture technique Dialysis Buttons for your Buttonholes. In my last post, I mentioned that it is becoming more common for units to get people started with buttonholing by inserting a plug into each needle hole for a couple of weeks so that buttonhole and tunnel formation are accelerated Ludlow (2010) Phase 1: Determine Use of the buttonhole Canada whether buttonhole technique demonstrated cannulation made a decreased cannulation difference between pain, slight start and finish of improvement or no study; determine change in arterial- confidence in nurses' venous pressures and ability to provide hemostasis times, buttonhole. intravascular stent(s), peripheral dialysis segment, including all imaging and radiological supervision and interpretation necessary to perform the stenting, and all angioplasty within the peripheral dialysis segment •99152: Moderate sedation, initial 15 minutes. Case Study #4

This type of dialysis is done using a catheter inserted into the abdomen and no blood is exchanged during this method. One exception is the needle stick required for lab work. Home hemodialysis (HHD) does require needles but special techniques, such as the buttonhole technique, are used to help make the process less painful. Myth #4 OUTCOMES: Bacterial growth from the buttonhole tract and dialysis cannula tip and clinically important infections during follow-up. MEASUREMENTS: On 3 occasions 1 month apart, cultures before dialysis (from the skin surrounding the buttonhole before disinfection and from the cannulation tract after disinfection and scab removal) and the cannula. It takes about six sessions to form buttonholes suitable for dialysis. At MFT, we train all our home HD patients to buttonhole. It can be difficult to use buttonholing in a dialysis centre unless the staff have received specific training. However, patients can learn the technique and do their own needling within the main unit—something we.