Clinical effects of buttonhole cannulation method on hemodialysis patients

[natnnnat]

Abstract

Just a bit of research into buttonholes...
Kim, M.-K. and Kim, H.-S. (2012), Clinical effects of buttonhole cannulation method on hemodialysis patients. Hemodialysis International. doi: 10.1111/j.1542-4758.2012.00753.x

from  http://onlinelibrary.wiley.com/doi/10.1111/j.1542-4758.2012.00753.x/abstract

Although the buttonhole cannulation method is now widely used as an alternative to the rope-ladder method in most countries, only the latter method is used in Korea. This study was performed to investigate clinical benefit of the buttonhole technique for arteriovenous fistula (AVF) cannulation in maintenance hemodialysis (HD) patients. Thirty-two patients receiving HD via mature AVF were included and AVF cannulation was performed by 20 experienced nurses. During the 8 weeks, AVFs were cannulated by the rope-ladder method with 15-gauge sharp needles. After creating of 2 pairs of tunnel tracks by sharp needles for 7 weeks, AVFs were cannulated by the buttonhole method using 15-gauge blunt needles during the 16 weeks. Vascular access blood flow rate (BFR), dialysis venous pressure (DVP), and dialysis adequacy (Kt/V) were measured within the first week of the two cannulation methods. Cannulation pain, hemostasis time, and nurse's stress were evaluated at the end of the two methods. There were no statistical differences in vascular access BFR (P = 0.139), DVP (P = 0.152), and dialysis adequacy (P = 0.343) between the two methods. However, the buttonhole method shortened hemostasis time (P = 0.001) and decreased cannulation pain (P = 0.001) as well as nurse's stress (P = 0.001) compared with the rope-ladder method. In conclusion, the buttonhole cannulation method improves hemostasis time, cannulation pain, and nurse's stress without a change in vascular access BFR and dialysis adequacy in HD patients.

[Hazmat35]

so, one is no better than the other? 

[amanda100wilson]

The flaw with this study from what I can see (given that I am only reading and abstract) is that it fails to measure,the long-term differences between the two, specifically, survivability of the fistula .  if you look only at this study, it suggests that there is no advantage to having a buttonhole other than for the reasons stated.   However, there is evidence that the buttonhole method preserves a fistula's use ability for longer.

[natnnnat]

I was about to say what Amanda just said.  I haven't any personal experience with buttonholes but I have read here that they keep your fistula lasting longer.
I'll find a link to a discussion about that and post it here.

[natnnnat]

this is the comment I was thinking of
http://ihatedialysis.com/forum/index.php?topic=23032.msg376295#msg376295
(turns out its only one comment in a thread not related to buttonholes, ah well).

I'll post text from the article in a moment
meanwhile, some discussions of buttonholes here
http://ihatedialysis.com/forum/index.php?topic=21348.msg353712#msg353712

a demonstration of using buttonhole is here
http://ihatedialysis.com/forum/index.php?topic=23049.msg375948#msg375948

[natnnnat]

I can't post the whole article for reasons of copyright.  Here's some selections.

Introduction
[...] The rope-ladder cannulation method avoiding previous puncture sites is usually applied, which prevents aneurysm and intimal hyperplasia, which can occur if cannulation is repetitively performed in one place.[3] However, there were some problems with this method. First, cannulation sites can be limited if AVF is short or curvy. Second, cannulation with sharp and large gauge of needles every time inevitably causes pain, reduction of patient satisfaction, and low quality of patients' lives.[4] In order to overcome these problems, the buttonhole method via establishing tunnel tracks enabling repetitive cannulation without complications has been developed.[2, 5, 6] This study aimed to evaluate the clinical efficacy of the buttonhole method by consecutively performing rope-ladder and buttonhole methods on the same patients. We investigated several parameters such as vascular access blood flow rate (BFR) (Transonic System Inc., Ithaca, NY, USA), dialysis venous pressure (DVP), dialysis adequacy (Kt/V), activated clotting time (ACT), hemostasis time, pain during cannulation, and the stress level of nurses cannulation.
[...]
Interventions
The rope-ladder method was applied during the first 8 weeks. AVF cannulation was performed by 20 nurses with more than 3 years of experience in our HD unit. The skin at the cannulation site was cleaned with alcohol and betadine. Two 15-gauge needles (Figure 1) were inserted in 20°–45°.[3] Arterial cannulation site was placed in the more distal segment of an access but at least 3 cm away from the AV anastomotic site. The venous needle was inserted more than 5 cm proximal to the arterial needling site, avoiding the place where it was cannulated before. [...]

During the next 7 weeks, 3 of 20 nurses involved in the rope-ladder method were cannulated fistulas to create buttonhole cannulation tracks after receiving standard education from the researchers. Two pairs of tunnel tract for the buttonhole method were established on venous and arterial needling sites, respectively, and used alternatively to prevent prolonged bleeding after needle removal following dialysis.[7] The sites for arterial and venous cannulation were chosen in the same way as the rope-ladder cannulation method (Figure 2). The same size sharp needles as used for the rope-ladder method were inserted.

[...]
During the last 16 weeks, 20 nurses have cannulated established buttonhole tracks. After cleaning the fistula with alcohol and Betadine, the scabs on the selected arterial and venous needling sites were removed. Two 15-gauge blunt needles (Figure 1) were inserted in 25° and 2 pairs of arterial and venous cannulation sites were alternatively used for a total of 16 weeks (8 week each).

During the period of the rope-ladder method, patients who stopped bleeding within 15 minutes, within 30 minutes, and after 31 minutes accounted for 21.9% (21.9%), 50.0% (53.1%), and 28.1% (25.0%), respectively (second investigation). In the buttonhole method, patients who stopped bleeding within 15 and 30 minutes were 46.9% (59.4%) and 53.1% (40.6%), respectively (second investigation), and there were no patients that took longer than 30 minutes. As a result, the rate of patients who stopped bleeding every 15 minutes in the buttonhole method was higher than that in the rope-ladder method (P = 0.001, Table 3).
[...]
The pain score during arterial and venous cannulation decreased from 6.1 points in the rope-ladder method to 3.3 points in the buttonhole method and 6.3 points in the rope-ladder method to 5.1 points in the buttonhole method, respectively (P = 0.001, Table 4). The stress level of nurses decreased by 1.9 points (from 5.5 to 3.7 points, P = 0.001). However, there were no significant differences in the convenience and the satisfaction level of nurses between the two methods. [...]

Discussion
[...] The research results showed that the buttonhole method significantly reduced the pain experienced by HD patients and coagulation time without compromising the function of AVF and the efficacy of HD compared with the rope-ladder method. In addition, the stress level of a nurse who performs cannulation was reduced significantly. Therefore, the buttonhole method is thought to be a more effective method than rope-ladder method if the patients with AVF have limited vein to be cannulated or are complaining of severe pain.

There are limited numbers of researches studying the difference of AVF patency between buttonhole method and rope-ladder method. van Loon et al. investigated the frequency of AVF interventions, with 75 patients receiving buttonhole method and 70 patients receiving rope-ladder method, and the results showed that patients receiving buttonhole method experienced subcutaneous hematoma and aneurysm less frequently and they reported that buttonhole method is superior.[8] However, this study was conducted retrospectively comparing different patient groups rather than comparing two methods with the same patients, and the study also failed to examine blood flow of AVF. Therefore, long-term prospective research with the same patients will be required for more accurate results.

 [... Previous] research observing long-term button whole cannulation reported that coagulation time and pain were reduced as time passed comparing with that at the start, and daily dialysis was more effective than thrice a week dialysis.[7]

[noahvale]

*

[natnnnat]