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Updated: Mar 24, 2026
Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
Pro: Buttonhole cannulation of arteriovenous fistulae
1Nephrology Program, Humber River Hospital, Toronto, Canada Department of Medicine, University of Toronto, Toronto, Canada.
Insights
Buttonhole needling for hemodialysis vascular access may offer advantages over traditional methods. Further research is needed to confirm benefits and refine techniques, especially for reducing infection risk in arteriovenous fistulae.
Area of Science:
- Nephrology
- Vascular Surgery
- Patient Safety
Background:
- Arteriovenous fistulae are preferred for hemodialysis but face challenges in adoption and long-term function.
- Patient concerns include access complications, pain, and cosmetic issues.
Purpose of the Study:
- To review the benefits and risks of the buttonhole needling technique for arteriovenous fistulae.
- To identify limitations in current research and explore potential improvements for infection reduction.
Main Methods:
- Narrative review of studies on buttonhole needling in hemodialysis.
- Analysis of existing literature on technique benefits, risks, and methodological limitations.
Main Results:
- Buttonhole needling presents theoretical advantages for patient outcomes compared to standard cannulation.
- Methodological limitations exist in current studies, and refinements may reduce infection risks.
Conclusions:
- The buttonhole cannulation technique requires further investigation to establish definitive benefits.
- Future research should focus on refining the technique to maximize advantages and minimize risks, particularly infection.
Abstract:
Arteriovenous fistulae remain the access of choice for most hemodialysis patients. However, several factors limit their uptake and long-term patency, resulting in suboptimal prevalent rates in many high-income countries. Patients place considerable value on the avoidance of vascular access complications, pain and disfigurement. The approach to cannulation is a modifiable practice that could improve patient-important outcomes, with buttonhole needling offering some theoretical advantages over the standard rope-ladder and area methods. In this narrative review, we summarize key findings of studies reporting the benefits and risks associated with the buttonhole method, highlighting methodological limitations as well as recent refinements to the technique that may represent potential opportunities for reducing infection risk. We highlight the need for greater certainty surrounding the potential benefits of the buttonhole cannulation technique and propose some directions for future research.
