Infection Rates Following Buttonhole Cannulation in Hemodialysis Patients

Area of Science:

• Nephrology
• Infectious Disease
• Vascular Access

Background:

• Arteriovenous fistula (AVF) is the preferred hemodialysis (HD) access.
• Buttonhole (BH) needling is increasingly used with blunt needles.
• Concerns exist regarding increased infection risk with BH needling.

Purpose of the Study:

• To evaluate the impact of BH needling on Staphylococcus aureus bacteremia (SAB) rates.
• To assess the effectiveness of nasal screening, eradication, re-education, and training programs.
• To compare SAB risk across different HD access methods.

Main Methods:

• Retrospective audit of 881 HD patients from November 2009 to May 2012.
• Patients categorized into central venous catheter (CVC), area needling AVF, and BH groups.
• Analysis of SAB incidence, mortality, and complication rates.

Main Results:

• BH and CVC access showed significantly higher SAB hazard ratios compared to AVF.
• Initial SAB rates per 1000 days were 0.21 for CVC and 0.15 for BH.
• Post-intervention, BH SAB rates decreased but returned to baseline; expansion led to CVC-like rates.

Conclusions:

• BH needling is associated with a higher risk of SAB compared to standard AVF needling.
• Interventions like re-education and asepsis policies did not sustainably reduce BH-associated infection risk.
• BH needling was limited to self-care patients due to persistent infection risks.