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A comparison of the buttonhole and rope-ladder AVF cannulation techniques and infection rates within the SCOPE
Heather A Morgans1, Heidi Gruhler De Souza2, Troy Richardson2
1Department of Pediatrics, Division of Nephrology, Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, USA. hamorgans@cmh.edu.
Insights
In pediatric hemodialysis (HD), the buttonhole (BH) cannulation technique shows a low blood stream infection (BSI) rate, similar to the rope-ladder (RL) technique. Further research is needed to compare pediatric and adult experiences with BH cannulation.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Vascular Access
Background:
- Adult studies suggest higher infection risks with buttonhole (BH) arteriovenous fistula (AVF) cannulation versus rope-ladder (RL) technique.
- Pediatric data on AVF cannulation infection rates is limited.
- This study addresses the sparse pediatric data regarding AVF cannulation techniques.
Purpose of the Study:
- To compare infection rates between BH and RL cannulation of AVF in pediatric hemodialysis patients.
- To evaluate access-related blood stream infection (BSI) and access site infection (ASI) rates.
- To provide evidence on the safety of BH cannulation in children.
Main Methods:
- Retrospective analysis of data from Standardizing Care to Improve Outcomes in Pediatric End stage kidney disease (SCOPE) centers.
- Comparison of infection rates between centers using BH versus RL AVF cannulation.
- Generalized linear mixed modeling to assess BSI and ASI rates.
Main Results:
- Data from 211 AVF enrollments (61 BH, 150 RL) in 210 children.
- Overall infection rate was low (12 infections in 3383 patient months).
- No significant difference in infection rates per 1000 patient months between BH (3.1) and RL (3.2) centers (p=0.947).
- BH centers reported strict antiseptic protocols and small patient/nurse ratios.
Conclusions:
- Pediatric hemodialysis patients using BH cannulation demonstrate a low blood stream infection rate.
- The infection rates for BH and RL cannulation techniques were comparable in this pediatric cohort.
- Further investigation is required to fully understand the pediatric versus adult experience with BH cannulation.
Background:
Studies regarding hemodialysis (HD) arteriovenous fistula (AVF) cannulation in adults indicate a higher risk of infection with the buttonhole (BH) technique compared to the rope-ladder (RL) technique. Pediatric data on this issue is sparse.
Methods:
We compared infection rates within the Standardizing Care to Improve Outcomes in Pediatric End stage kidney disease (SCOPE) centers performing BH cannulation versus RL cannulation of AVF. Generalized linear mixed modeling was used to assess differences in access-related blood stream infection (BSI) and access site infection (ASI) rates between the centers.
Results:
Data was available from 211 AVF enrollments among 210 children. There were 61 AVF enrollments at 6 BH centers and 150 enrollments at 13 RL centers. Demographics were similar between the two groups. There were 12 total infections in 3383 patient months. BH centers had 3 infections (0 BSI, 3 ASI) and RL centers had 9 infections (5 BSI, 3 ASI). Mean [95% confidence interval] infection rates per 1000 patient months were not different between BH and RL centers (BH: 3.1 [0.6,15.6], RL: 3.2 [1.3,9.4], p = 0.947). A survey was also completed by the BH centers to describe their BH practices. The BH procedure at the majority of sites was characterized by a small patient/nurse ratio and strict antiseptic protocols.
Conclusions:
This data provides evidence of a low BSI rate associated with BH cannulation in pediatric HD patients. Further studies are needed to better delineate the differences in the pediatric and adult experience with the BH cannulation technique.
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