Complications of the Buttonhole Technique

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Why You Meet Resistance Manipulating theneedleflaptunnelneedlefistula wall Patient drinksexcessively (“afterthe weekend” effect)flaptunnelneedle Tourniquet vs. notourniquetfistula wall**dashed line – correct tunnel positionsolid line – displaced buttonhole tunnel
Well-Developed AVF Walls“Trampoline Effect”Difficulty getting the bluntneedles into the fistula –Why?1. Thick-walled fistulas2. Blunt needles werenot pointed enoughSEMI BLUNTAvailable needlestypical AVF vs. thick-walled AVF(Dr. Twardowski personal correspondence, 2006; Milburn et al, n.d.)
Page 11: Taut (tight) Skin Anchors the Veina
Page 16 and 17: Best Demonstrated PracticeTouch Can
Page 18: Best Demonstrated PracticeCushion C
Page 24 and 25: Cannulation - Site PreparationClean
Page 26 and 27: Do’s and Don’ts of Scab Removal
Page 28 and 29: Best Demonstrated Practice2-Step Sk
Page 30 and 31: Infection: A Bigger Problem…Tunne
Page 32 and 33: ProtectingEstablishedButtonhole Sit
Page 34 and 35: Buttonhole Technique IssuesNeed to
Page 36 and 37: In Closing…Consistency RulesAll s

Complications of the Buttonhole Technique

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