Korean J Med.  2014 Nov;87(5):574-578. 10.3904/kjm.2014.87.5.574.

Clinical Experience with Buttonhole Needling in a Single Hemodialysis Center

• Choi SJ
• Cho EH
• Lee SH
• Oh HR
• Kim JH
• Park MY
• Kim JK
• Hwang SD

• KMID: 2269198
• DOI: http://doi.org/10.3904/kjm.2014.87.5.574

Abstract

BACKGROUND/AIMS
The buttonhole technique, in which needle insertion during cannulation is always into the same site, confers advantages including ease of cannulation, ease of achieving hemostasis, and reduced pain compared with rope-ladder needling. We introduced the buttonhole technique in hemodialysis patients experiencing pain during needling. None of the disadvantages associated with the buttonhole technique, such as infection or access events, were observed, due to the short duration of the study.
METHODS
Patients undergoing buttonhole needling were observed prospectively. Data were collected on the following parameters: infectious complications, hospitalizations and access events. We compared buttonhole and rope-ladder needling using baseline data.
RESULTS
A total of 48 patients (34 males; mean age = 49.4 +/- 13.8 years) were enrolled. Seven patients were excluded: in three patients, the buttonhole technique failed to form a tract, three others underwent kidney transplantation, and one was lost to follow-up. The remaining 41 patients were followed for 15.7 +/- 4.7 months. Thirteen patients suffered infections, as follows: local infections (n = 5), pneumonia (n = 3), bacteremia (n = 2), cellulitis (n = 1), osteomyelitis (n = 1), and liver abscess (n = 1). There were no significant differences between the rope-ladder and buttonhole needling techniques in rates of infection, hospitalization or vascular access events.
CONCLUSIONS
The infection rate and access event frequency associated with buttonhole needling did not differ in relation to that of rope-ladder needling.

Keyword

Buttonhole cannulation; Arteriovenous fistula; Hemodialysis

MeSH Terms

Arteriovenous Fistula
Bacteremia
Catheterization
Cellulitis
Hemostasis
Hospitalization
Humans
Kidney Transplantation
Liver Abscess
Lost to Follow-Up
Male
Needles
Osteomyelitis
Pneumonia
Prospective Studies
Renal Dialysis*