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The buttonhole technique for fistula cannulation: pros and cons
Rajneet K Atkar1, Jennifer M MacRae
1aSouthern Alberta Renal Program bDivision of Nephrology, Department of Cardiac Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada *On behalf of the Alberta Kidney Disease Network.
Current Opinion in Nephrology and Hypertension
|October 1, 2013
Summary
Buttonhole cannulation may reduce pain and complications like hematomas but carries an increased infection risk. This technique is complex and best for challenging fistula sites, requiring strict infection control.
Area of Science:
- Nephrology
- Vascular Access
- Hemodialysis
Background:
- Buttonhole cannulation is gaining interest for potential fistula outcome improvements.
- Recent randomized trials necessitate a review of its benefits and risks.
Purpose of the Study:
- To review the benefits and harms of buttonhole cannulation.
- To compare buttonhole cannulation with rope ladder technique.
Main Methods:
- Review of observational studies and five randomized trials.
- Analysis of pain, infiltrations, hematoma, aneurysm formation, and infection risks.
Main Results:
- Buttonhole cannulation does not appear less painful than rope ladder when performed by nurses.
- Consistent reduction in infiltrations, hematoma, and aneurysm formation reported.
- Increased risk of infection and septic complications associated with buttonhole cannulation.
Conclusions:
- Buttonhole cannulation is complex in an in-center setting with rotating staff.
- Consider buttonhole for difficult or limited fistula needling sites.
- Infection prevention and audits are critical; future research should focus on home hemodialysis patients.
