Managing 'buttonhole' complications

Cannulation problems in vascular access can be a cause for significant morbidity, mortality and risk loss of access site. Buttonhole cannulation has been promoted as a method of arteriovenous fistula (AVF) cannulation that has fewer complications and is more patient friendly (1, 2). Widespread use of this technique has resulted in several publications raising concerns about the complications associated with this technique. This article attempts to understand the anatomic and physiologic basis for this technique and may provide explanations for some of these complications. A clear understanding of the mechanism of function of this technique might help mitigate some of the complications and help devise techniques to reduce others. It focuses on evaluation of the buttonhole to identify the infectious problems that may predispose to bleeding and their management.