New Buttonhole Fistula screening protocol

[JMan]

From Barts Health (London)

I am writing to you because you are a "Home Haemodialyis" patient.

This letter is important to you if you "button hole" needle your dialysis fistula (use "blunt" needles).

You might be aware that people who "button hole" their fistula have a higher rate of infections. However, there are benefits to "button hole" needling.
1) Prolonged fistula life span
2) Prevent and reduce your fistula developing aneurysms
3) Is less painful during needling
4) Has less bleeding after haemodialysis

Overall, we believe that people who perform their dialysis at home have fewer infections that than people who have their dialysis in the hospital. But, if you are worried about the increased infection risk with button holing or if you want to change to "sharp needling", please contact me or a member of the Home HD Team.

To reduce the risk of you getting an infection, we want to start a "Screening Program".

We shall routinely perform swabs of your nose and fistula every 3 months.

We shall swab the inside of your nose and the skin over your fistula when you come to have your "Monthly Bloods" in January, April, July and October.

If these swabs show that you are "colonised" by Staph aureus bacteria, we will ask you to use special body washes and a special antibiotic ointment for your nose.

If you have any questions, please contact me or a member of the Home HD Team.

Yours Sincerely

[Johnylefox]

I am having fistula inserted on Tuesday.
None of this has been discussed with me.
I just know PD is not working for me.
Good luck.

[wagolynn]

Hi,

They will start to use your fistula, when it is ready, using the 'ladder' method, this is said to help the fistula to develop.

Ladder - The needles are inserted at a fresh point on the fistula at each session, they generally start low down on your arm, and move up a few millimetres each time like steps in a ladder.

Once the fistula is settled then button hole has some important advantages, see the letter above.

Button Hole - The needles are inserted in the same holes every time, at first they use sharp needles but after around three times they will change to blunt needles.
This works because scar tissue forms to make a tube down to the blood vessel, the tube guides the needle, if the operator knows what they are doing that is, many do not.
At each session the scab has to be removed from the outer end of the hole. This scab is thought to be the main way of carrying bacteria into the blood stream, which is what the letter is about.
The scab usually comes off very easily.

[JMan]

I am having fistula inserted on Tuesday.
None of this has been discussed with me.
I just know PD is not working for me.
Good luck.

Heres a bit of info on http://esrdncc.org/ffcl/for-ffcl-patien ... materials/

http://www.nhs.uk/Conditions/Dialysis/P ... ormed.aspx

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