How are the needles secured and protected during NHHD?
As for the specifics of needle fixation … this is a very individualised thing. Every access and fistula is different – in anatomical size/shape and location – and as such, fixation can vary a little from patient to patient. For fistula needling, we favour the buttonhole technique first developed by Twardowski. We also use specially designed blunt tipped buttonhole-specific steel needles. Although the earlier NHHD work done by Pierratos used plastic cannulae, we found them harder to insert and feel the blunted steel needles are the better way to go. We use rotating buttonholes (2 for each of the venous and arterial sites) and use simple tape fixation. In Toronto, they use Morborg adhesive Velcro tapes. Although I personally liked these, my nursing staff has preferred simple tape. In any event, the Morborgs arent available in Australia, the cost of importing them was high and simple tape fixation has turned out to be very successful. One does need to be careful to tape the needles corr
