Buttonhole puncture: a new technique from the past

Abstract

Introduction. The Buttonhole technique described in the 1970s, and not further explored, may represent a valid alternative for the management of arteriovenous fistula; the limitations which caused the decline of this technique were high incidence of infections compared to the rope ladder or constant site techniques.

Methods and Results. Creating a protocol to allow nursing training and uniformity of action in order to minimize the risk of infection and to benefit from the positive outcomes resulting from this technique. In Centers where BH was never performed we suggest to establish a small pilot group to experiment BH technique, first selecting patients with easily prickable fistulas, to minimize negative outcomes; when operators have reached a good level of dexterity and safety, the entire nursing team may be trained. Subsequently the pilot group will include more complex patients and gradually increase the number of patients suitable for BH; data collection and monitoring will allow continuous verification of the good progress of the project.

Conclusions. BH technique can represent the most appropriate solution especially for difficult venipuncture cases and for the implementation of self venipuncture in home dialysis.