A time-saving method of creating AVF buttonholes: indwelling trocar technique

Area of Science:

• Nephrology and Vascular Access Surgery
• Hemodialysis Techniques
• Medical Device Innovation

Background:

• Buttonhole cannulation offers advantages over rope-ladder technique for hemodialysis patients.
• The method of buttonhole establishment is crucial for successful and safe vascular access.
• Existing techniques require optimization for patient comfort and clinical efficiency.

Purpose of the Study:

• To evaluate the convenience and practicality of using indwelling trocars for establishing buttonholes.
• To compare the indwelling trocar method with the traditional sharp needle technique.
• To assess key outcomes including formation time, pain, success rate, and infection risk.

Main Methods:

• Prospective, observational cohort study over 12 months.
• Comparison between 30 patients using sharp needles and 33 using indwelling trocars for buttonhole creation.
• Data collected on buttonhole formation time, cannulation pain, success rate, AVF infection, and patency, adhering to STROBE guidelines.

Main Results:

• Indwelling trocar group showed significantly shorter buttonhole formation time (5.48 vs. 23.23 minutes, p < .01).
• Initial cannulation pain was lower in the indwelling trocar group (p = .002), with no significant difference after one month (p = .169).
• Higher success rate (100% vs. 83.8%, p = .02) and a trend towards fewer AVF infections (0% vs. 9.7%, p = .102) were observed with indwelling trocars.

Conclusions:

• The indwelling trocar method offers reduced buttonhole formation time, less initial pain, and potentially fewer infections.
• This technique enhances patient comfort and protects the arteriovenous fistula (AVF).
• The findings support indwelling trocars as a convenient and practical approach for clinical use, warranting further research into AVF infection causes.