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Updated: Jun 2, 2026
Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
A randomised controlled trial of buttonhole cannulation for the prevention of fistula access complications
Josephine Chow1, Glenda Rayment, Susana San Miguel
1Area Cardiovascular Stream, Sydney South West Area Health Service, Australia. Josephine.Chow@sswahs.nsw.gov.au
Insights
The buttonhole cannulation technique for haemodialysis fistulas led to more infections, haematomas, and site pain compared to the traditional rope ladder rotation method. Further research is recommended to fully understand its safety and efficacy.
Area of Science:
- Nephrology
- Vascular Access Surgery
Background:
- Vascular access is crucial for haemodialysis.
- Minimizing complications and maximizing access longevity are key goals.
- The buttonhole cannulation technique is an alternative to traditional methods.
Purpose of the Study:
- To compare the buttonhole cannulation technique with the standard rope ladder rotation technique.
- To evaluate complication rates and access survival in haemodialysis patients.
Main Methods:
- A multicentre, prospective, open-label, randomised controlled trial.
- Seventy subjects were randomised into buttonhole and control groups.
- Buttonhole group used sharp needles initially, then blunt needles; control group used rope ladder rotation.
Main Results:
- The buttonhole group experienced more infections (p=0.11) and significantly more haematomas and site pain (p<0.05).
- No significant difference in infection rates was observed between groups.
- The rope ladder rotation technique showed fewer complications.
Conclusions:
- Buttonhole cannulation resulted in increased infections, haematoma formation, and site pain compared to rope ladder rotation.
- The findings suggest potential drawbacks of the buttonhole technique regarding safety and patient comfort.
- A larger-scale longitudinal study is recommended to validate these findings.
Objectives:
This multicentre, prospective, open label, randomised controlled trial was to determine whether buttonhole cannulation technique in new and established haemodialysis fistula reduced complications and prolonged the access life compared to usual practice.
Method:
Seventy subjects were recruited for this study. Subjects randomised to the buttonhole group had their fistula cannulated by the same staff member for two to four weeks at the same angle and direction with sharp needles. Once the tunnel was developed, blunt needles were used. The control group continued with usual practice (rope ladder rotation technique).
Results:
Infection at the cannulation site occurred in four patients in the buttonhole group and one in the rope ladder rotation group (p = 0.11). Haematomas at the cannulation site and site pain experienced during the dialysis session were more often recorded for the buttonhole group (p < 0.05).
Conclusions:
This study showed that buttonhole cannulation resulted more infections, haematoma formation and site pain during dialysis than with the rope ladder rotation group. A further larger scale longitudinal study is recommended.
