Buttonhole Yes or No? Maybe, Cautiously…

Abstract

Arteriovenous (AV) fistula cannulation plays a key role in the management of dialysis sessions, and is crucial for the reinforcement of the patient-to-staff relationship. Compliant patients prefer the buttonhole technique (BH); however, this “funnel” shows a high risk of infections. It is like a short catheter and, therefore, carries an increased risk of infectious complications. The BH cannulation should therefore be considered as a part of the complex planning of VA utilization, including rope-ladder cannulation as the standard of care, and should be reserved to selected patients. Also, prostheses cannulation should be taught and practiced in order to reduce the use of central venous catheters (CVC). In addition, cannulation should be considered as a part of the complete managing process of VA, together with the phases of creation, monitoring, and repair of the vascular access. The dialysis nurse must be considered both as the primary caregiver and the manager of this life-warranting pipeline.