I recently had an infection in my fistula near the puncture site. It started off with pain, some swelling and then eventually a small discharge of puss and fever.
I use the buttonhole technique and there have been studies that have linked this technique with a higher infection rate. It is however much less painful than using the regular sharp needles. Some proponents of this technique say that improper technique is the cause of the infections among those who do buttonholing not buttonholing itself.
Well, I have been having recurrent infections ever since I started buttonholing. I have been getting an infection almost every year. I take a course of antibiotics and the infection subsides.
This time however, the infection returned in about eight months. This was worrisome. I looked up the vascular access management group's paper from the Global HHD forum I am a part of and found some things that I have been doing wrong. I also posted on the Home Dialysis Central FB page and got some very useful tips from the buttonholing veterans there! I then added some common sense to what I learnt and here are some changes I have made in my technique:
I use the buttonhole technique and there have been studies that have linked this technique with a higher infection rate. It is however much less painful than using the regular sharp needles. Some proponents of this technique say that improper technique is the cause of the infections among those who do buttonholing not buttonholing itself.
Well, I have been having recurrent infections ever since I started buttonholing. I have been getting an infection almost every year. I take a course of antibiotics and the infection subsides.
This time however, the infection returned in about eight months. This was worrisome. I looked up the vascular access management group's paper from the Global HHD forum I am a part of and found some things that I have been doing wrong. I also posted on the Home Dialysis Central FB page and got some very useful tips from the buttonholing veterans there! I then added some common sense to what I learnt and here are some changes I have made in my technique:
- 'Double prep': Someone on the FB group suggested that I 'double prep' my sites. Generally I do only a 'single prep' - clean the sites with a disinfectant only once (before removing the scabs). The suggestion was to clean before and after removing the scabs. I've started double prepping now.
- Scab removal: With buttonholing, you need to remove scabs that form after the last dialysis on the puncture site. I used to use the same needle to remove both the arterial and venous scabs. This could be a potential cause of infection. So, I now use two different needles to remove the scab.
- Lignocaine injecting: I need to inject a little lignocaine (a local anaesthetic) before I cannulate. I would use the same insulin syringe to inject at both sites. I now use two different insulin syringes to inject the lignocaine - one for each site. I also clean the top of the lignocaine vial with some disinfectant before taking the lignocaine.
- Different pair of gloves for closing: I generally cannulate myself and the tech who helps with my dialysis does the closing. I would use a sterile pair of gloves and we would preserve that for closing. Tch tch. We now use a different pair for closing.
Some of these things might seem obvious to you. However, for whatever reason, I did compromise. Part of it was cost saving (I pay all my medical expenses out of pocket). Part of it was laziness. Part of it was plain inertia. I realise now that the price to be paid is heavy for these compromises.
Hopefully I have learnt my lesson and will not take any chances now. A fistula is a dialysis patient's lifeline. We must protect it at all costs!
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