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Updated: Jan 20, 2026
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Published on: May 31, 2022
Arteriovenous Buttonhole Access Cannulation in Pediatric Patients on Hemodialysis
Tyson Moore1, Stephanie Brightman2, David L Dodson3
1Nurse Practitioner, Children's Mercy Kansas City, Kansas City, MO.
Insights
Buttonhole cannulation of arteriovenous fistulas (AVF) is safe for pediatric hemodialysis patients. This study found no increased infection risk, supporting its use in children over 20 kg not receiving transplants soon.
Area of Science:
- Nephrology
- Vascular Access
- Pediatric Dialysis
Background:
- Arteriovenous fistula (AVF) is the preferred hemodialysis access for pediatric patients >20kg awaiting transplant >1 year.
- Buttonhole cannulation in adults is linked to infection risk, but pediatric data is scarce.
Purpose of the Study:
- To evaluate the safety and efficacy of buttonhole cannulation in pediatric hemodialysis patients.
- To assess the infection risk associated with buttonhole cannulation in pediatric AVFs.
Main Methods:
- Retrospective chart review of buttonhole cannulated AVFs in a single pediatric hemodialysis unit.
- Analysis of approximately 5,600 cannulations over 215.5 patient-months.
Main Results:
- 93% of patients (13 of 14) experienced no AVF or adjacent skin infections.
- No infections were reported despite numerous cannulations, suggesting a low risk profile.
Conclusions:
- Buttonhole cannulation can be safely performed in pediatric hemodialysis patients.
- The technique does not appear to increase the risk of infection in this population, contrary to some adult data.
Abstract:
The arteriovenous fistula (AVF) is the recommended hemodialysis access for pediatric patients who weight more than 20 kg and who are not expected to receive a kidney transplant for one year or longer. Whereas buttonhole cannulation of the AVF has been discouraged in adults because of the associated risk of infection, the published pediatric experience with this technique is extremely limited. A retrospective chart review of all buttonhole cannulated AVFs in a single pediatric hemodialysis unit was performed. Approximately 5,600 cannulations were performed over 215.5 patient months with no infections of the AVF or adjacent skin in 13 of 14 (93%) patients. Results from this experience provide evidence that the buttonhole cannulation technique can be successfully performed in pediatric patients on hemodialysis without an associated increased risk of infection.
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