The Feasibility of the Button-Hole Technique for Self-Cannulation

Abstract

The button-hole (BH) is a well-known alternative technique of venipuncture of arteriovenous fistulas (AVF). In our dialytic centers (U.O. of San Gavino and Center of Serramanna) we treated 42 patients using this technique from 2009 until today. At first we only used it in difficult or aneurysmatic AVF, but we soon extended the indication to all the AVFs of new formation; moreover, we selected a group of young and motivated patients for self-puncture and cannulation. In this last group of patients and in those of the Serramanna’s Center, we obtained the best results in terms of reduction or absence of complications, especially infections. The BH, much more than the “rope-ladder” or the “area” techniques of venipuncture, needs a definite protocol and a strict follow-up. Being evident that pain and hemostatic time are sharply reduced by BH, we believe that it is worthy or unique when self-cannulation and home treatment are programmed.