Buttonhole Tunnel Tract Creation with the BioHole® Buttonhole Device

Area of Science:

• Nephrology
• Vascular Access
• Dialysis Technology

Background:

• Skilled cannulation is crucial for maintaining arteriovenous fistulas (AVFs) in hemodialysis patients.
• The buttonhole cannulation method, revived in the 2000s, aims to improve AVF preservation but presents implementation challenges.
• The BioHole® device is a sterile polycarbonate peg designed to create a consistent buttonhole tract for cannulation.

Purpose of the Study:

• To describe the method of creating a buttonhole tract using the BioHole® device.
• To outline the advantages and disadvantages of using the BioHole® device for AVF cannulation.
• To provide evidence-based recommendations for buttonhole cannulation in hemodialysis.

Main Methods:

• Utilizing a thumbtack-shaped 5-mm peg (BioHole® device) to establish a fixed puncture route within 7-14 days.
• Repeatedly inserting the peg after needle removal and achieving hemostasis, followed by dialysis completion.
• Transitioning to blunt-ended needles once the buttonhole tunnel is formed.

Main Results:

• The BioHole® device facilitates rapid creation of a buttonhole tract (7-14 days).
• Advantages include reduced needling complications, AVF failure, and infection risk, with suitability for difficult cannulation sites.
• Potential disadvantages include initial cost and temporary discomfort, bleeding, or infection risk, which decrease with blunt needle use.

Conclusions:

• Buttonhole cannulation using the BioHole® device is a recommended technique for most hemodialysis patients with native fistulas.
• The method promotes a speedy transition to safer blunt needle cannulation.
• Adoption of buttonhole cannulation aligns with KDOQI (2006) and UK Renal Association (2011) guidelines.