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...everything you need to know about doing dialysis at home.
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. Fear of someone new putting in your needles may even keep you from traveling. But you can reduce your stress and feel less pain by putting in your own needles.
If you plan to do home HD, learning to place your needles (self-cannulation) will be part of your training. Learning that skill ahead of time can get you over a hurdle and help shorten your training time. You can learn to put in needles with your left hand if you are right handed, or vice versa. You do need to be able to see and to move your wrist, hand, and fingers.
When you learn to put in your own needles, you are literally taking control into your own hands—that’s a great feeling. In this article, we’ll cover why it’s best to put in your own needles, getting past the fear, how to put in needles, and the buttonhole technique.
You’ve heard that your access is your lifeline, and it’s true. Each person only has about 10 sites that can be used to make a fistula or graft for HD access. So, it’s vital to keep each one as long as possible. The best way to do this is to have one, consistent person placing the needles. And the only person who goes to all of your HD treatments…is you.
A fistula is a direct link from your own artery to your own vein—all your own tissue—so it’s less likely to get infected or clotted. It is the best type of access and most likely to help you live longest.1 A graft is a piece of artificial tubing used to link your artery and vein together. It is more likely to need hospital “tune-ups” to remove clots, and more prone to infection.
When your access is infiltrated (the needle punctures both walls of the access), blood leaks into the tissues and causes swelling, and often a painful bruise. The escaped blood can compress your access. This may cause stenosis (narrowing of the blood vessel) and/or a blood clot that could damage your access—or even cause it to fail.
When someone else puts needles in, they can only feel the outside of your access. Since your access is in your arm or leg, you can feel the inside and the outside. Plus, each person may use a different angle to put the needles in—while you would use the same angle each time.
Both of these factors give you a built-in edge that no one else has, not even a professional. You are much more likely to do a good job. Your access may last years longer if you put your own needles in (and this helps reduce your stress level). Some fistulas have lasted 30 years or more.
There’s no question that it can be hard to get up the nerve to put in your own needles. But people who do it say that they must focus so hard on getting the needle in that it distracts them from the pain. So, it hurts much less, which is a plus.
* If needle pain or fear of needles is an issue for you—as it is for many—please be sure to read our article called Dialysis Needle Fear: Easing the Sting.
You can take baby steps to get used to the idea of putting in your own needles:
* Note: Some centers worry that they will be sued if they let people self-cannulate. Others say they can’t allow it if they are not certified by Medicare for self-care or home dialysis. Neither of these is true. No center has ever been sued for letting patients self-cannulate. (Putting in your own needles is safer than having someone else do it.) Plus, Medicare supports self-cannulation as part of the Fistula First program to raise the numbers of people who have fistulas. No self-care or home certification is needed.
You can learn how to put in needles by having a professional show you, step-by-step, what to do. It’s more of an art than a science. There are few studies to guide how things are done. Each center does the steps a bit differently; it’s best if you follow the steps the way your center or home training nurse prefers. Here are the basic steps:
When needles are removed from your access, they leave small holes. Over time, with many treatments, those holes must be carefully managed to avoid damage. Too many needles in the same small area can cause weak spots that can “balloon” out to form aneurysms (the “lumps and bumps” you may have seen on a long-term access). In a graft, there is only one way to prevent this: rotating needle sites. But in a fistula, there are two ways: rotating needle sites or using the buttonhole technique.
The buttonhole technique is also called “constant-site cannulation.” It’s not a device; it’s a different way of putting in the needles. Instead of rotating sites, you choose two sites (one for each needle) and use them only. At each treatment, you put the needles in exactly the same spots at exactly the same angle. In 8-10 treatments or so, scar tissue will form around the needle into a tunnel—like a pierced earring hole—at each site to guide the needles into your fistula.3 The small holes, next to each other, look like the ones in a button.
When this happens, you use special, blunt needles that are much less likely to infiltrate or to change the track. People who use the buttonhole technique say that it is less painful than using a sharp needle at each HD treatment and when rotating needle sites. Once the tunnels are formed, it is usually quite easy to place the needles. Research shows that you are less likely to get aneurysms with the buttonhole technique.4
To use the buttonhole technique, you:
Medisystems, which makes the blunt needles that are used for the buttonhole technique, has a helpful brochure and a video so you can see this for yourself. You can download the brochure here, or call 800-369-MEDI to order the Constant-Site Cannulation with Buttonhole® Needles video.
Putting in your own needles is a vital self-care skill that will help preserve your access so you can feel your best and have more control over your treatment. When you can put in your own needles, you always know that you have an expert cannulator close at hand. This can free you up to travel or think about doing home HD.
Copyright © 2006 Medical Education Institute, Inc. All rights reserved.
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