Buttonholes and risk of Endocarditis

[Cowdog]

I do self care dialysis in center and have used buttonholes for several years, self cannulation. Yesterday the young lady who is responsible for accesses came to talk. She said my Dr had requested that she visit with each patient using buttonholes and inform/warn that there is a study that indicates that the use of buttonholes has an increased risk for developing endocarditis. She had a document for me to sign that we did indeed have the discussion and I was given education material (best practices to avoid infection in buttonholes). I asked for the name of the study and any particulars (#of patients, Self vs staff cannulation, etc), she didn't have any info other than what the Dr said.
Anybody else had this discussion with your Healthcare professionals or have any info on the study?
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[JW77]

I was under the impression that it was fairly well known that buttonholing increased a risk of infection. Particularly from MRSA.

I've had a few close shaves with infection.  I started using an antibacterial wash on the fistula daily (The same wash given to me in the hospital when I was being treated) I've been lucky, or sensible and haven't had an infection near my access for over a year.

The wash is called Octanisan, and I have it on prescription via my GP (UK)

[PrimeTimer]

I think pre-washing the fistula with antibacterial soap then swabbing the buttonholes with alcohol pads and/or antiseptic and gloving up is KEY.
My husband has been self-cannulating using the buttonhole method for a little over 2 years now. He was hospitalized last summer for a staph infection but (per a vascular surgeon, his buttonholes were not infected). The disease control doctor told him it was from a common bacteria found on everyone's skin and to not beat himself up over it. By the way, ever since then he has gloved up before he sticks himself...

The most recent study I could find online is an old one posted October 26, 2012 from the CKJ Clinical Kidney Journal titled "Arterio-venous fistula buttonhole cannulation technique: a retrospective analysis of infectious complications" April 24, 2012


And no, his doctor or Neph has not mentioned any recent studies about the risk of buttonholes and endocarditis and they haven't made him sign a form stating as such.

[Simon Dog]

I have never had a buttonhole infection.  My protocol is to clean with alcohol wipes; mask up; clean again; descab; clean agan; canulate.

BUT... when I was scheduled for my fistula surgery, I had a tiny cut on my finger.  It got infected, and the entire finger started turning red.  My primary care doc put me on bactrim, and my neph upgraded that to IV vanco.   It eventually started blistering, and the pain was intense (so much that my primary offered me oxy which I declined).   Although never proven, the suspected culprit was MRSA as I had recently been in the hospital for 17 days.  The fistula surgery was delayed for a couple of weeks since nobody involved wanted MRSA in the OR.

That experience gave me a general fear of infection, and I never take any shortcuts on procedures when canulating.

[Cowdog]

I follow the infection control best practices except for glove on sticker hand. Trying to tape down with a glove on doesn't work for me. I'm the only person I ever see using the sinks and soap going into the center. I have only had one occurrence of infection in a buttonhole but that time had an assignable cause and was 100% my fault. I splashed a mixture of diesel fuel, recycled motor oil and insecticide on it while recharging a cattle back rub, (I bet don't very many of y'all have one of those). Even though I washed immediately it still became infected or perhaps just very very irritated. I abandoned that site and started a new BH, Dr prescribed few IV vanco bags to be safe, redness and swelling cleared up quickly.

The studies I've found seem to link infection rates to personal hygiene practices of the patients and who (self vs staff) was doing the cannulation.
Thanks for responding to my question!