BUTTONHOLE CANNULATION: SHOULD THIS BECOME THE DEFAULT TECHNIQUE FOR DIALYSIS PATIENTS WITH NATIVE FISTULAS?
Summary of the EDTNA/ERCA Journal Club discussion Autumn 2007

Abstract

The paper discussed during autumn 2007 was a report entitled 'Cannulating in haemodialysis: rope-ladder or buttonhole technique?' published in Nephrology Dialysis Transplantation. The authors agreed to follow the discussion and respond to points raised. Twenty-three expert contributors from 13 different countries provided evidence, opinion and historical insights into vascular access techniques for chronic haemodialysis patients. All contributors who had introduced the buttonhole technique for patients with native arterio-venous fistulas (AVFs) had found benefits for patients in terms of ease of cannulation, reduced pain and even reduced aneurysm formation. The discussion included expert advice on needling protocols, track formation and the sharp versus blunt needles debate. The buttonhole technique is virtually unheard of in some countries and the discussion covered some of the potential barriers to its introduction and offered advice on also how to overcome some of these issues.

Patients’ Perspectives of Constant-Site (Buttonhole) Cannulation for Haemodialysis Access

“…The risk of developing these complications has been suggested to be greater with the standard rope ladder technique rather than buttonhole technique [17]. If this is correct, then why has the buttonhole technique not become more universally practiced?…”

Local Hemodynamics of the Vascular Access for Hemodialysis

“…Enormous dilatation (aneurysms) develops in some patients. The puncture technique plays a substantial role in the development of aneurysms [52,53] . Basically, 3 methods of access cannulation are used: (1) rope ladder cannulation (changing the puncture sites along the access); (2) area puncture cannulation (punctures within a short access segment), and (3) buttonhole technique (punctures into exactly the same sites).…”

Buttonhole Cannulation and Clinical Outcomes in a Home Hemodialysis Cohort and Systematic Review

“…The BH technique was initially introduced with hopes of preserving access in short AVFs (5). The perceived benefits of reduction in problematic cannulation episodes (4,(6)(7)(8) and patient discomfort and lower requirement for AVF interventions have led to a resurgence in the use of BH cannulation, specifically in the home hemodialysis (HHD) setting (6,7,(9)(10)(11)(12)(13). Recent studies have suggested increased infections in patients using BH cannulation; however, definitive evidence is lacking (8,10,14).…”