The buttonhole technique for fistula cannulation

Atkar, Rajneet; MacRae, Jennifer M.

doi:10.1097/mnh.0b013e328365ae9e

Cited by 33 publications

(16 citation statements)

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“…To combat the higher infection rate we observed with the buttonhole technique, an intensive re‐education program was introduced, restricting the number of trackers to a maximum of two, and only permitting “blunt” needles to be used once the track was established, coupled with a strict asepsis policy. Smaller centers have reported that the introduction of education programs have been very effective in reducing the infection rate , and others have reported the importance of an ongoing educational program coupled with audit cycles to reduce infection rates . Although we did note a reduction in the incidence of SAB following the changes in education and aseptic policy, these were short lived, and infection rates increased once again.…”

Section: Discussioncontrasting

confidence: 52%

Infection Rates Following Buttonhole Cannulation in Hemodialysis Patients

et al. 2016

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Arteriovenous fistula (AVF) is the preferred access for hemodialysis (HD). Buttonhole (BH) needling has increased following the introduction of "blunt" fistula needles. Although some reported advantages for BH needling, others have reported increased infection risk. As such we reviewed our center practice, and the effect of both nasal screening and eradication and re-education and training programs. We audited the outcomes of 881 HD patients dialyzed between November 2009 and May 2012, divided into three groups: 175 dialyzing exclusively by central venous catheter (CVC), 478 exclusively by area needling AVF (AVF) and 219 by BH. There were 31 Staphylococcus aureus bacteremias (SABs); 14 (45.2%) dialyzing with CVCs, 12 (38.7%) BH and five (16.1%) AVF. The 30 day mortality rate for SAB was 7.5% with a complication rate of 22.6%. The hazard ratio for first SAB was significantly greater for both CVC and BH access compared to AVF (5.3 (95% CI -1.9-18.6), P < 0.001 and 3.6 (1.3-96), P = 0.011, respectively). During the study SAB rates per 1000 CVC days were 0.21, compared to 0.15 for BH. After major re-education and asepsis technique campaigns the SAB rate for BH fell to 0.06, but quickly returned to 0.17. Extending BH needling to all our dialysis centers, SAB infection rates increased to those not dissimilar to CVC access. Despite re-education programs coupled with a strict asepsis policy and active SA eradication, followed by audit cycles, the increased infection risk with BH remained, such that we have limited BH to self-care patients.

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Section: Discussioncontrasting

confidence: 52%

Infection Rates Following Buttonhole Cannulation in Hemodialysis Patients

et al. 2016

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“…There have been a number of published systematic reviews 69 – 71 on the impact of the different puncturing technique on the incidence of AVF-cannulation pain, all with equivocal results, showing various limitations, such as incomplete literature search 69 or even overall poor quality and substantial heterogeneity among studies that precluded pooling of outcomes. 70 Pain arising from AVF access was common and often multimodal in nature, frequently leading to avoidance or shortening of dialysis sessions and even abandonment of otherwise well-functioning AVF.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent hemodialysis: a systematic review

Brković¹,

Burilovic²,

Puljak³

2016

PPA

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ObjectivesUnderstanding the epidemiology of pain in patients on hemodialysis (HD) is crucial for further improvement in managing pain. The aim of this study was to systematically review available evidence on the prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent HD.Materials and methodsWe carried out a systematic review of the literature and developed a comprehensive search strategy based on search terms on pain and HD. We searched the databases MEDLINE, Scopus, PsycINFO, and CINAHL from the earliest date of each database to July 24, 2014. Manuscripts in all languages were taken into consideration. Two authors performed each step independently, and all disagreements were resolved after discussion with the third author. The quality of studies was estimated using the STROBE checklist and Cochrane risk-of-bias tool.ResultsWe included 52 studies with 6,917 participants. The prevalence of acute and chronic pain in HD patients was up to 82% and 92%, respectively. A considerable number of patients suffered from severe pain. Various locations and causes of pain were described, with most of the studies reporting pain in general, pain related to arteriovenous access, headache, and musculoskeletal pain.ConclusionThe findings of this systematic review indicate high prevalence of pain in HD patients and considerable gaps and limitations in the available evidence. Pain in this population should be recognized as a considerable health concern, and the nephrology community should promote pain management in HD patients as a clinical and research priority to improve patients’ quality of life and pain-related disability.

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“…Algo semejante sucede con los resultados encontrados para las infecciones, ya que algunos autores asocian el método BH con mayores tasas de infección en comparación con el método escalera 10,23,25 , coincidiendo con los resultados encontrados por otros autores 27,31,32 . Sin embargo, Smith et al 24 en su estudio afirmó no encontrar ninguna relación en cuanto a las tasas de infección y la utilización de dicho método.…”

Section: Discussionunclassified

El método buttonhole como técnica de punción de la fístula arteriovenosa en hemodiálisis: Una revisión de la literatura

Amador-Marín

Martínez-Montilla

2016

eglobal

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Nº 44 Octubre 2016Página 341 REVISIONESEl método buttonhole como técnica de punción de la fístula arteriovenosa en hemodiálisis: Una revisión de la literatura RESUMENIntroducción: La hemodiálisis es el tratamiento de elección en los pacientes con insuficiencia renal crónica. La clave para un tratamiento adecuado es tener un buen acceso vascular. Por ello, las fístulas arteriovenosas son consideradas la mejor opción. Uno de los principales factores que influyen en la supervivencia de estas es la técnica de punción realizada. El objetivo principal del estudio fue conocer el método buttonhole como técnica de punción de la fístula arteriovenosa en la hemodiálisis.Metodología: Se realizó una revisión de la literatura científica a través de las siguientes bases de datos: PubMed/Medline, Scopus, Cinahl y Cuiden Plus, desde 2011 hasta 2016. Además, se realizó una búsqueda secundaría manual.Resultados: Las estrategias iniciales de búsquedas identificaron un total de 84 resultados, siendo finalmente seleccionados 7 estudios. Los resultados encontrados han sido muy diversos, encontrándose resultados para el dolor, tasas de infección, tiempo de hemostasia, dilataciones aneurismáticas, flujo sanguíneo, presión venosa, número de intentos de canulación, seguridad, estética del brazo portador de la fístula y calidad de vida del paciente. Conclusiones:El método buttonhole parece ser una buena alternativa de punción, ya que está prácticamente exenta de las complicaciones habituales existentes en otras técnicas, como extravasaciones, hematomas, aneurismas, entre otras. Además, facilita la auto-punción en los domicilios. Por otro lado, es necesario un buen aprendizaje previo a la incorporación de esta técnica y un periodo de adaptación por parte de los profesionales, requiriendo implicación por parte de los mismos y del centro.

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The buttonhole technique for fistula cannulation

Cited by 33 publications

References 20 publications

Infection Rates Following Buttonhole Cannulation in Hemodialysis Patients

Infection Rates Following Buttonhole Cannulation in Hemodialysis Patients

Prevalence and severity of pain in adult end-stage renal disease patients on chronic intermittent hemodialysis: a systematic review

El método buttonhole como técnica de punción de la fístula arteriovenosa en hemodiálisis: Una revisión de la literatura

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