Original Paper
Patients’ Perspectives of Constant-Site (Buttonhole) Cannulation for Haemodialysis AccessJanice Warda, Kate Shawa, Andrew Davenportb
aBarnet Dialysis Centre, Royal Free Hospital, and
bCentre for Nephrology, University College London Medical School, Royal Free Campus, London, UK
Address of Corresponding Author
Nephron Clin Pract 2010;116:c123-c127 (DOI: 10.1159/000314661)
goto top of page Key Words
* Haemodialysis
* Arteriovenous fistula
* Cannulation
* Buttonhole cannulation
* Blunt needle
goto top of page Abstract
Introduction: The advent of blunt needles for arteriovenous fistula cannulation has led to a resurgence in the buttonhole technique. Although successful for home haemodialysis patients and those who self-cannulate, we introduced this technique into one of our satellite dialysis centres. Methods: Audit of buttonhole cannulation in 53 adult haemodialysis patients, 29 male, mean age 68.5 ± 1.9 years. Twelve (23%) patients started de novo and 41 (77%) had previously been using sharp needles with the rope ladder technique. Results: Typically, the needle tract was developed after 8–10 cannulations depending on the tracker nurse and vessel. Ninety-three percent of the patients reported shorter venepuncture bleeding times after needle removal, 81% less pain on needling and 80% improved appearance of the fistula compared to sharp needle rope ladder technique. Fistula recirculation rates fell from 9.3 ± 0.4 to 8.3 ± 0.3% (p = 0.016), as did fistuloplasty requirement during a median follow-up of 14 months (range, 9.5–22.5; χ2 = 5.6, p = 0.008). Conclusions: Buttonhole cannulation can be successfully introduced into a busy satellite dialysis centre. Patient satisfaction improved due to lower pain scores, shorter bleeding times after needle removal and improved appearance of the fistula. Recirculation rates and requirement for fistuloplasty were also reduced.
Copyright © 2010 S. Karger AG, Basel
goto top of page Author Contacts
A. Davenport
Centre for Nephrology
University College London Medical School, Royal Free Campus
Rowland Hill Street, London NW3 2PF (UK)
E-Mail andrew.davenport@royalfree.nhs.uk
goto top of page Article Information
These data were presented as a poster at the 2009 American Society of Nephrology meeting in San Diego, Calif., USA.
Received: January 4, 2010
Accepted: January 29, 2010
Published online: May 21, 2010
Number of Print Pages : 5
Number of Figures : 5, Number of Tables : 0, Number of References : 19
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