Davita's policy of no blunt needles!!

[Geminimom]

YOU NEED TO BE MORE EDUCATED ON BUTTON HOLES VERSUS SHARP NEEDLES.
I AM PERFECTLY HAPPY HAVING A FISTULA THAT IS NOT HUGE DUE TO SCARRING OF SHARP NEEDLES. YOUR POLICY OF HAVING ONLY SHARP NEEDLES IS VERY DISCONCERTING.I DO NOT LIKE BEING TOLD WHAT TO DO WITH MY BODY.
I WANT TO HAVE BLUNT NEEDLES NOT SHARPS. SHARPS HAVE A HIGHER PERCENTAGE OF INFILTRATION!!!!!! IT SCRAPS AGAINST THE BACK OF MY VEIN WALL WHILE I AM HAVING TREATMENT!! IT CAUSES LARGER FISTULAS DUE TO SCARRING!! I AM AT THE VICTOR VALLEY CLINIC AND I AM TICKED OVER THIS!!
I WANT THE OPTION OF EITHER OR!!:

[stumpr54]

Hello Geminimom,

I've been an HHD patient since my start on hemodialysis through HHD training in July 2012. My HHD clinic, DaVita Bluemound At Home in Wauwatosa, WI is one of the pioneers in the development of soft touch cannulation using blunt dialysis needles in button hole access. They developed two buttonholes in my not yet mature fistula (the result of a much needed fistulogram owed to chronic infiltrations and subsequent new vessel development) that I was able to cannulate with 15GA blunt dialysis needles and start treatments at home.

Since March 2013 I have developed 8 button hole sites using repetitive sticks (4 to 7) with sharp dialysis needles, which can then be cannulated with blunt dialysis needles. Five of the 8 button hole sites are currently in use. The original two sites and three others were abandoned for a variety of performance issues. If it were not for button hole access and blunt dialysis needles, my AVF access would be hopelessly traumatized from endless sticking with sharp needles, my arm would be chronically sore from infiltrations and my record of not missing a treatment in my 5X weekly HHD regimen would be shot.

I have treated in center at DaVita clinics in Denver, Kansas City, KS, Kansas City, MO and Greenville, SC. I have yet to see a patient in center that is treating with blunt dialysis needles and buttonholes. I know they exist (e.g. kcramer). I have come to understand the reason for the adherence to sharp dialysis needles is the ease and speed at which the dialysis nurse or technician is able to get a patient running and the reduced risk of infection, e.g. no scab fragments to push into the vessel/blood stream. Button hole access does requires scab removal and additional aseptic prep of the arm as well as a more time consuming technique of getting the blunt needle into the access. However, the patient comfort during cannulation and running with blunt needles as well as the near impossibility of infiltration seem to outweigh the up front time.

Once my needles are in place, taped down and my blood lines secured with elastic velcro arm bands (forearm fistula), there is virtually nothing that I cannot do with my access arm during the course of a treatment. I have complete freedom of movement and no fear of infiltration.

You may have to find a different DaVita clinic that supports and practices the development of button hole access and the use of blunt dialysis needles. Good luck.

[kcramer]

germinimom: I am one of two people in center that uses blunt needles. I have been self cannulating since the end of April. I do not use aseptic prep but I do wash my site when I get into the room. The tech sits and prepares needles and tapes while I use the alcohol that soften the site. I take off the scabs with tweezers. The tech then hands me the needles and tapes down the needles. It does not hurt and I get the job done faster than some techs. When I went on vacation the first time, the center I went to was private and they requested I bring my own blunt needles which my center supplied. I went on a second vacation in NC and they had many who used blunt needles with no problems. They provided the blunt needles and I had a real good experience. You just need to find the right clinic and be willing to tell them that you are in control of your treatment. Being positive and taking control of your treatments is important. My nurses and techs know I listen to everything they say about my treatment and I question them if anything is not norm or what I expect. The doctor also knows I ask a lot of questions and feels I am doing well being positive and in control. I am not demanding just knowledgeable. I learned early on that you must take control and let them know you understand what is going on. If you do it with a nice attitude and polite they treat you much better. http://www.homedialysis.org/ is a good place to find some information.

[dac0214]

Um...Geminimom....there is a little button on the left side of your keyboard, marked "caps lock". Please, press it once.

[Geminimom]

It is under my understanding that this is Davita wide decision....is it not?

[stumpr54]

It is not a DaVita wide decision. It is a decision that is left up to the management/administration of each individual DaVita clinic. Each clinic's performance is measured regularly on an assortment of performance results, most of which pertain to patient health/outcomes. Patient nutritional results from monthly labs represent a large portion of the clinic's "score". Management of phosphorus, potassium, calcium, albumin, Kdt/V (clearance), hemoglobin for each patient all contribute to that score.

Additionally, patient hospitalizations - for any reason, will detract from that score, as do patients with venous catheters. Yes, patient vascular access is a contributor to the clinic's score. The more patients that have arteriovenous fistulas the higher that score. The more patients with central venous catheters or arterio venous grafts, the lower the score for patient vascular access.

Because there is an increased risk for a vascular access infection (2 in 1000 blunt/buttonhole, vs. 1 in 1000 sharp), many DaVita clinics refuse to take that additional risk and will not use buttonhole and blunt dialysis needle access. The decision is influenced by the medical staff including the nephrologists and nurses that are responsible for patient care and health.

My first in-center experience while on a business trip to Golden, CO was at Davita S.W. Denver Dialysis near Littleton, CO. I was naturally curious to see how the "other side" dialyzed as well as the staff practices. I inquired about button holes and blunt needles and was informed that they did not observe these practices and in fact they were expressly forbidden because of the increased risk of infection. As it turns out, this Davita clinic was among the top 10% of Davita clinics nationwide in terms of their monthly clinic scores. DaVita S.W. Denver Dialysis' staff and administration clearly valued and protected their very high ranking.

I've visited four other Davita clinics around the USA and while their facility scores couldn't match those of Da Vita S.W. Denver Dialysis, none actively encouraged the use of button hole vascular access with blunt dialysis needles, but most were aware of the button hole technique, and at least one did have blunt dialysis needles on hand. In preparation for this potential barrier, my HHD clinic suggested that I bring with me all the supplies that I use for a treatment (alcohol sponges, gauze pads, band aids, tweezers, alcohol, etc.), not the least of which would be sets of blunt dialysis needles in the event that the clinic did not have a supply.

[dac0214]

I remember about 30 years ago, my mother had the misfortune of starting dialysis at a hospital-run clinic that jealously guarded it's "hepatitis free" rating so much that if she were to EVER dialyze at any center that was not considered "hepatitis free", she would not be able to come back to that center. It created a great problem when she traveled down to visit my sister when she was having her first baby, requiring her to go some 60 miles to the nearest acceptable clinic.

A couple of years later, she got a transplant. After several years, the transplant failed, and she went back on dialysis, at a different clinic. When she asked about the whole "hepatitis free" aspect of the old clinic, the nurses told her that, in the long run, that particular clinic had been no better or worse than any of the others in the area. Sometimes rules sound good at first, so they just keep slavishly following them, I guess.

[Elaan27]

Surprising that no one has mentioned this since 2014. I have been on dialysis since 2012 and started at a Liberty dialysis back in Ct.They told mr about buttonhole from day one of dialysis and have been on it ever since.But I moved to NC last year in 2015 to a Fresinius left there because of terrible facility and treatments and Found a Davita much closer to me.But they tell me they don't do buttonhole because 'Davita' says they have a high infection rate! Well sorry do not think that way and will never give up my buttonhole treatment!My body my decision,don't you agree with me?

[DebbyRig]

When I went to a class from Davita here in Virginia the nurse giving the class said that they do buttonhole. This was a year ago. I don't know if anything changed here as I am not on dialysis but at the time they did. Maybe it is a center by center decision. I don't know.

[stumpr54]

Unless you self-cannulate, you will not likely get support for buttonhole technique at any in-center dialysis clinic. The combination of the time investment made in developing buttonholes, as well as the varied techniques required for cannulating them, require time and effort that in-center dialysis clinics do not have.

I have five different buttonhole sites that I created after being taught the technique through HHD training in 2012. All tolled, I've created 9 different buttonhole sites in that time frame. Because of changes in my fistula resulting in cannulation challenges, I've had to abandon sites and develop new ones.

The process of cannulating each of these sites has changed over time and required slight changes in technique. I could not expect anyone other than the day after day cannulator - me, to be able to successfully cannulate these buttonhole sites. The 4X or 5X weekly repetition develops the skills and experience needed to assure success. Having that expectation of dialysis techs and nurses in an in-center dialysis clinic conducting treatments every other day during the week is simply unreasonable.

Self cannulate if you wish buttonhole access or subject yourself to sharps and the rope and ladder technique.

[Elaan27]

My buttonholes are in my upper arm and I wear glasses now and can't do my own,as with Liberty in Ct and Fresinius the techs should be able to provide this for patients that's why we pay for the great care we get,I think sharp needles can do more harm than blunt personally.Take it from me I had someone recently take a short sharp needle and use it on me,thanks to her my arm turned black and blue It made a huge painful bump on my arm and to top it off never got an apology for the mistake,but every other nurse and tech there apologized and it was not their fault.I thank god for the nurse that was on an realized that it was the wrong needle and took care of me.To this day not one person higher up at the unit has apologized.

[74041ham]

Well if Davita would allow patients to do self care in the center it would relieve the techs from that time, while they could be setting up the machine, asking you how your day is going or talk to you like your human and not just a chair with a pulse, or reviving the person next you, they would be right there if you were to have any problems. I definitely don't want other people picking at my scabs thank you very much. It would save a lot of staff time if Davita would maybe spend five minutes to train a capable person how to do it if they want to.

[FloridaGirl]

I'm at Gulf Breeze Davita in Dunedin, FL. Many of the clients have buttonholes. I was encouraged to start buttonholes as they think I am a good candidate for HHD. I said no to the buttonholes. The surgeon who created my fistula (after my graft had finally given up the ghost) made me promise--No buttonholes. The whole process of pulling out the scab, etc. is just not for me. I can't even remember the last time my fistula was infiltrated, and I've been on dialysis 8 1/2 years--6 years with the fistula. I think the clinics should offer the option, but button holes aren't for everyone.

[jcnopetheone]

I know my vascular surgeon says that rope ladder tec is better depending on how the fistula depth

[Tabbyleg]

It is faster for them to use sharp needles and they don't have to be as accurate. When using blunts you have to hit the flap exactly which takes a longer. They are on a strict time table to get you out as quickly as possible. I have had St. Luke's hospital in Houston actually kick me out to the hallway right after treatment because i was a few minutes late getting stuck with a blunt. When i had to bring my own from home. This is very common.