AV Fistula Buttonhole Leaking

[Kirsten27]

I am the caregiver for my spouse on home hemo dialysis and have been for close to three years now. Home hemo has been great for him and it has given him his life back.
However, recently we have been having some issues with his but hole for his venus line. 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. Although this may be what we have to do I still want to know what caused this in the first place because if there is something wrong with the way I am inserting the needle I do not want to repeat the mistake with the new buttonhole. I think the problem may have been because we continued to used sharp needles even after the track had formed. Has anyone else had this problem? If so what was the cause and how was it resolved? Any information would be much appreciated

[stumpr54]

Dialysis needles, whether sharps or blunts are tapered, e.g. the diameter at the bevel is smaller than that at the end that connects to the tube. There are two likely explanations of the site bleeding: one is the condition of the skin and tissue in the tract - it has probably lost the elasticity that provides the "grip" on the needle and provide an effective seal on the needle the other is that the use of a sharp in the site has cut away additional tract tissue and has increased the diameter of the tract beyond that which is needed to achieve a tight seal on the needle.

Developing a new buttonhole site is probably your best recourse, and doing so in a time frame before the existing venous site becomes unusable. While the new site is in use, the tract tissue on the abandoned venous site will likely grow back and its likely that this site could be used successfully in a matter of weeks. I did not experience the site bleeding your spouse has experienced but I did experience continued difficulty in cannulating my venous buttonhole about 6 months after its development. The strengthening and growth of the fistula in the area of the venous buttonhole caused misalignment of the fistula flap and the tract that led to a longer tract, which reduced the length of needle I could advance into the fistula.

Knowing that it was a matter of time before I could no longer "reach" the fistula flap, I started developing a third buttonhole site with 15 gage sharps and had it in use a few weeks before I could no longer cannulate the original venous buttonhole site.

I had aspirations of developing additional buttonhole sites but business travel prevented me from the consecutive sharp sticks and treatments needed until August and September of 2013 when I developed another 3 buttonhole sites. The timing of the first of these was once again advantageous as my original arterial site had become inflamed - but not infected (received 3 doses of IV antibiotics as a preventative measure) and I was instructed not to use the site. Thanks to having the new site operable, I was able to stay on my 5X weekly HHD treatment schedule.