Buttonhole needling of haemodialysis arteriovenous fistulae results in less complications and interventions compared to the rope-ladder technique

Abstract

This study showed that the BH method is a valuable technique with few complications like haematoma, aneurysm formation and the need for interventions. However, the infections induced by the BH method should not be underestimated. This underlines the importance of an aseptic and correct technique of the buttonhole procedure.

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

“…Of these studies, eight studies reported total infections (6,7,14,(16)(17)(18)(19)(20), five studies reported systemic infections only (21)(22)(23)(24)(25), and one study reported only local infections (8). There were four RCTs (16,17,19,20) and three observational studies comparing units with different cannulation methods (7,14,23), and the remaining eight studies were observational studies comparing before and after changes (6,8,18,21,22,24,25) (Table 3). Most of the studies were single-center, observational studies, and all were published after 2007; the total number of patients included was greater than 1612 in the majority of the studies.…”

“…Most of the studies were single-center, observational studies, and all were published after 2007; the total number of patients included was greater than 1612 in the majority of the studies. The studies were conducted in the United States, Europe, Canada, and Australia; four studies were conducted in an HHD setting (8,14,(22)(23)(24)(25), seven studies were conducted in an in-center hemodialysis setting (6,7,(17)(18)(19)(20)(21), and four studies were conducted in both settings (16). Most of the studies were graded as low level of evidence (Supplemental Table 3 (Figure 3).…”

“…The desired benefit of BH cannulation is a reduction in patient pain. Observational studies have predominantly reported BH as being associated with reduced pain (6,8), whereas one study showed an increase in cannulation pain (7). Three of four RCTs assessed the impact on patient comfort.…”

“…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).…”

Experiência inicial com a técnica de Buttonhole em um centro de hemodiálise Brasileiro

“…[7][8][9]15,18 During track formation, perfect insertion of blunt needles was not feasible between the eighth and twelfth cannulation. Thus, the use of blunt needles was reprogrammed from the thirteenth cannulation on, regardless of the etiology of the chronic kidney disease.…”