​​​​​​​​​​​​​​At home

• Check your buttonhole sites and the skin around them every day. Call your hemodialysis unit right away if:
  • you have a temperature over 38 °C (100.3 °F) with or without chills
  • the buttonhole site is red, swollen, painful, tender, or warm to touch
  • there is anything leaking (discharge) from the site
  • you notice any changes to your buttonhole sites
• If your buttonhole site is bleeding, cover it with clean gauze, and put pressure on it with your fingers. Apply direct pressure until the bleeding stops.



NOTE: If the bleeding does NOT stop after 10 minutes, call 911 or go to your nearest emergency department.

• Clean your buttonhole sites every day by washing your arm gently with soap. Rinse and pat dry around the sites using a clean towel.
• Do NOT use body lotions or creams, perfume, or powders near your buttonholes.
• Protect your buttonhole sites:
  • Do NOT irritate the site by hitting, poking, or picking the site. It is best not to touch it except when cleaning the site.

Using your buttonhole sites for dialysis at the hemodialysis unit or home

• Do NOT put EMLA® cream on your access arm before hemodialysis.
  
• Before each dialysis:
  1. Wash your hands and your access arm with soap, rinse with clean water, and pat dry.
  2. Use an alcohol swab (2% chlorhexidine gluconate in 70% alcohol) to clean each site. Use a circular motion for 15 seconds from the inside out.
     
  3. Let the site air dry.
  4. Take off the scab with a sterile device.
  5. Using another alcohol swab, clean the site again in a back and forth friction ​motion for 15 seconds.
  6. Let the site air dry.

  The sites are now ready to needle.​

• Before rinseback: If you are taking out your own needles, first clean your hands using 2 to 3 mL (about ½ teaspoon) of Microsan®. Rub until dry.
• After dialysis:
  1. Take out the needles, put gauze over the site, and put pressure on the site to stop the bleeding. This usually takes about 5-10 minutes.
     
  2. Use sterile gauze to put a small amount of antibiotic cream/ointment or antimicrobial impregnated gauze over the buttonhole sites.

  OR
  

  3. Cover the buttonhole sites with sterile gauze or antimicrobial impregnated gauze. Do NOT use Gelfoam® or Surgicel® after dialysis. Tape over the buttonhole site and leave dry dressing for 12 – 24 hours.