The first description of the constant site needle insertion was published in the Polish literature in 1977, and two years later in Dialysis & Transplantation. While those publications did not create much interest, they were noted by Belding H. Scribner, the father of chronic hemodialysis (HD), who taught the method to one of his home HD patients, A. Peter Lundin, who also informed George Harper, another home HD patient from Georgia, about the advantages of the method. But the method was not widely used prior to publication of my 1995 paper in Dialysis & Transplantation. In this paper, I suggested that the method was not widely used due to prevalent graft use, “multiple sticker” practice for buttonhole creation, and the lack of blunter needles. When the method was developed in Poland two kinds of needles were used, very sharp and blunter, which were becoming even blunter because they were reused. This seemed to be advantageous for the constant site method, as a blunter needle tended to go through the established path without cutting the insertion tunnel wall. Blunter needles were not available in the U.S. at the time. Both of the home hemodialysis patients noted above inserted the needles by themselves and were skillful enough to insert them through the established paths, even using sharp needles. The history of the publication of this 1995 paper is interesting. Harper was very much interested in new HD machines. He contacted Rodney S. Kenley, president of AKSYS Ltd., which was in the process of developing a home HD machine based on my patents, and told him about the buttonhole method of needle insertion. In 1994, Kenley called me asking whether I was aware about this method apparently suitable for home HD. I told him that I was aware, as I was the first who described it, but that I was not successful in introducing it into our center in Columbia. He prodded me to work on this problem, as it might be important for our home HD program. I decided to intensify my efforts to introduce this method in the United States, so I submitted the paper to D&T, and invited George Harper to our 1st Symposium on Home Hemodialysis in Baltimore, where he presented his experience with the method. I was also able to get cooperation from William J. Schnell, an engineer at Medisystems Research Corporation in Lakemoor, Ill., to manufacture blunter needles. Gradually, the method started to be used at our Columbia center, and in other centers. Videos were produced describing this technique, and every year more information was presented at the conferences. Other companies (Nipro and JMS North America) started to manufacture blunter needles. Blunter needles are suitable for the use in an established track, which is created with sharp needles during 8 to 12 hemodialysis sessions. As a consequence of the publication in D&T, I received multiple queries from patients and nurses regarding details of the technique. Many nurses started to push for the use of the constant site method and got permissions from nephrologists. Several centers in Seattle, Toronto, Louvain (Belgium), Maastricht (Netherlands), Brazil, and New Zealand started to use the buttonhole method, particularly in home HD patients, with positive results, and most home HD patients started to use this method. Stewart Mott, RN, a blood access nurse at our center in Columbia, Mo., Tony Goovaerts, a nurse from Louvain, Belgium, and Emma Vaux, MD, a consultant nephrologist from Reading, England are very active in buttonhole needle insertion research. Recently, Magda van Loon from The Netherlands, successfully defended her PhD thesis on blood access, with a large portion related to the buttonhole method of needle insertion. I also received an e-mail from Rosa Marticorena, a nurse at St. Michael's Hospital, Toronto, Ontario, Canada, that she plans to write a PhD thesis on the buttonhole method. One of the most active researchers of the buttonhole method was Lynda Ball, RN, BSN, CNN, from the Northwest Kidney Center in Seattle, where many daily dialysis patients were being treated. In an e-mail sent to me in August 2007, she remarked that “buttonhole has caught on like wildfire.” And indeed, numerous papers on the method are being published—all stressing lower pain, lower hematoma formation, fewer missed needle insertions, and better fistula preservation.