An Overview of the Buttonhole Technique

A convenient insertion process for patients doing kidney dialysis

Patients who suffer from end-stage kidney failure (when approximately 80 to 90 percent of kidney function is lost) may be put on dialysis at the recommendation of their doctor. Dialysis is a treatment that helps do the things the kidneys can no longer do, like remove waste and prevent fluid buildup in the body, regulate vitamins and minerals, and help control blood pressure.

There are two types of dialysis—hemodialysis, which is when an artificial kidney is used to function as a real kidney inside the body, and peritoneal dialysis, which is when a doctor inserts a catheter into the abdomen to help rid the body of waste from the inside out.

In the case of hemodialysis, doctors must make an entrance into your blood vessels in order to get blood running through the artificial kidney. This can be done in a few ways: first, by creating a fistula—joining an artery and vein in your arm, a graft—which uses a tube to join the artery and vein together, and second, by using a catheter—a soft tube that is placed in a large vein, usually in the neck. In the case of a fistula access center, the buttonhole technique can be used when inserting dialysis needles.

The Buttonhole Technique

Only when patients have a fistula access (not a graft or catheter) can the buttonhole technique be used. To do this, dull dialysis needles are inserted into the same holes in the fistula.

Because the needles are going into the same area each time, this technique is thought to be less painful since new holes aren’t being created by sharper needles. Scar tissue forms a tunnel for the dialysis medication to travel through.

The term “buttonhole” refers to the two button-like holes the needle creates—one in the skin and the other in the fistula wall.

Buttonhole Pros

One of the biggest benefits of this technique with dialysis patients is that after approval from their healthcare provider, patients can do the buttonhole technique on themselves (called self-cannulation, the process of inserting needles into yourself). This means the dialysis can happen in the comfort of their own home or when traveling instead of at a hospital or medical center.

The buttonhole technique can also help keep your access point for dialysis open longer and, as a study found in the journal Kidney International found, fistula access will most likely help you live the longest out of the three access options, making the buttonhole technique even more crucial.

Buttonhole Cons

While the process of inserting the needles is not painful due to the strength of the needles and re-insertion into the same holes, many patients are wary of self-cannulating, and there may be a fear factor to get over before mastering the technique. A training nurse will teach you ways to access your fistula, the proper angles to hold the needles during insertion, how to tape them down, and how to remove them once the dialysis is done. Even so, the only way to conquer the uneasiness of doing the buttonhole technique on yourself is to practice it.

It’s also extremely important to practice good hygiene with the buttonhole technique, as infection at hole sites is a top concern for healthcare providers. A staphylococcus infection can occur if non-sterile equipment is used, especially because patients on dialysis typically have more staph germs on their skin.

Buttonhole Pros

  • Patients can do the buttonhole technique on themselves

  • Can help keep your point for dialysis open longer

Buttonhole Cons

  • "Fear factor" of inserting needles into yourself

  • Risks of infection at hole sites if non-sterile equipment is used

Preventing Infection

In order to have a clean access site and prevent infection, start every self-cannulation by washing your hands as well as the access site. Remove any scabs from the last dialysis treatment (which a training nurse or medical provider will show you how to do) and then wash your hands and the access site again, drying skin off completely.

Using a tourniquet or blood pressure cuff to find the fistula easier, insert the needles as shown by your provider and tape them down for the remainder of the dialysis. After the treatment is done, remove the needles and apply pressure to the sites to prevent large blood clots from forming.

As an extra precaution, wear a mask when inserting and removing the needles as well as a new rubber gloves each time you self-cannulate to help prevent germs from spreading.

A Word From Verywell

Deciding whether the buttonhole technique can be done as self-cannulation or under the supervision of a medical provider is a discussion you will have with your doctor. And just because you can self-cannulate with this technique doesn’t mean you have to. Medical staff and trained nurses will always do the insertion for you if you prefer.

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