Buttonhole Technique and Self-Cannulation

Abstract

Introduction. Cannulation of the vascular access for hemodialysis (VAH) is a procedure rarely debated among researchers. In the U.O. of Nephrology and Dialysis of the San Gavino's Hospital, policies of VAH protection and surveillance have been implemented through education and training not only of the staff but also of the patients and their relatives. To achieve the goal of VAH prolonged survival, in 2009 we chose a constant-site venipuncture technique, the buttonhole technique, which Twardowsky recommended in case of short or difficult arteriovenous fistulas (AVF). Experience of the U.O. of Nephrology and Dialysis of San Gavino Hospital. Our experience shows that 35 out of 40 patients, as well as 11 out of 16 nurses that performed VAH, found this method satisfying. Reduced or no pain during needle insertion and sensibly reduced post-dialytic hemostasis time are reported in 34 patients. Infections by Sthafilococcus Epidermidis have been reported in 6 patients (3 cases of sepsis and 3 cases of buttonhole localized infection). Aneurismal dilation, stenosis, or thrombosis have not been reported among the “buttonhole” group of patients to date. We trained 6 patients to self-manage their buttonhole sites and they are now autonomously carrying out their hemodialysis treatment. Conclusions. We think that the buttonhole technique has prolonged the fistulas' survival as a vascular access; during our 4-year experience we observed that the buttonhole procedure must be approved, accepted, and then strictly followed by the staff. This technique has allowed us to train patients to self-manage their hemodialysis procedure, and among this group of trained patients we did not observe any infection. We estimate that this result may be due to the VAH management by one or mostly two operators, and thus we believe that the buttonhole technique is particularly suitable for those who follow a program of home-dialysis.