Why I gave up using buttonhole needles after 19 years

I started home dialysis in 2006 and began using buttonhole needles around the same time. At first, it was impossible to get these needles in India. So, I asked a family friend who was a doctor in California to prescribe and order them. Then, a relative or friend would bring them back to India for me.

The buttonhole needles really helped because they made cannulation almost painless. At that time, I didn't insert the needles myself and had a technician do it for me. The buttonhole needles were so pain-free that if I looked away, I wouldn't even know when the needle went in.

Soon after, I began inserting the needles myself. This was a big confidence booster and made the pain even less. Over the years, I kept using the buttonhole technique and worked on improving how I inserted the needles. I also focused on improving on the cleaning technique for the sites before inserting the needles to lower the risk of infection. Although I did get some infections, they were usually treated successfully with antibiotics.

I also had a few other problems with buttonholes. The main issue was that the cannulation site would get bigger and bigger. This caused blood to ooze from the site during dialysis. When this happened, I had to stop using that site and choose a new one.

It's now been about 19 years since I started using buttonhole cannulation. Over time, I've noticed that the area where I insert the needles has become harder to use. I've had issues like high negative arterial pressures and problems with venous pressure as well. I have also had two instances where the vein would not get repaired on its own and required surgery to fix them. Overall, the frequency of these problems with buttonholing kept increasing.

A few weeks ago, after thinking about it a lot and feeling a bit scared, I decided to switch to using sharp needles completely. I stopped using buttonhole needles. Now, I use a numbing gel, which is an ointment with prilocaine and lidocaine. I put this gel on about an hour before inserting the needles. Then, I use sharp needles for the cannulation. While it's not as smooth and pain-free as the buttonhole needles, it's not too bad either.

I plan to keep using sharp needles from now on and stop using buttonhole needles. I hope this change will fix the problems I've been having.

One thing to note though - I am, by no means, saying no one should use buttonhole needles. I love buttonhole needles and would switch back if I was able to. I used them with decent success for 19 years! So, please do not take this post as one arguing against the use of buttonhole needles.