Cannulating in haemodialysis: rope-ladder or buttonhole technique?

Abstract

Compared with the rope-ladder technique, the buttonhole method offers the advantage of an easier cannulation procedure with less bad sticks, which has a special benefit for patients with limited access cannulation sites or with a fistula which is difficult to cannulate. Prolonged compression times or re-bleeding episodes did not occur, but precautions have to be taken in order to prevent infectious complications. The buttonhole method can contribute considerably to the cannulating ease of self-cannulating patients, thus providing a better quality of life.

Buttonhole Cannulation and Clinical Outcomes in a Home Hemodialysis Cohort and Systematic Review

“…Of these studies, eight studies reported total infections (6,7,14,(16)(17)(18)(19)(20), five studies reported systemic infections only (21)(22)(23)(24)(25), and one study reported only local infections (8). There were four RCTs (16,17,19,20) and three observational studies comparing units with different cannulation methods (7,14,23), and the remaining eight studies were observational studies comparing before and after changes (6,8,18,21,22,24,25) (Table 3). Most of the studies were single-center, observational studies, and all were published after 2007; the total number of patients included was greater than 1612 in the majority of the studies.…”

“…Most of the studies were single-center, observational studies, and all were published after 2007; the total number of patients included was greater than 1612 in the majority of the studies. The studies were conducted in the United States, Europe, Canada, and Australia; four studies were conducted in an HHD setting (8,14,(22)(23)(24)(25), seven studies were conducted in an in-center hemodialysis setting (6,7,(17)(18)(19)(20)(21), and four studies were conducted in both settings (16). Most of the studies were graded as low level of evidence (Supplemental Table 3 (Figure 3).…”

“…The desired benefit of BH cannulation is a reduction in patient pain. Observational studies have predominantly reported BH as being associated with reduced pain (6,8), whereas one study showed an increase in cannulation pain (7). Three of four RCTs assessed the impact on patient comfort.…”

“…The BH technique was initially introduced with hopes of preserving access in short AVFs (5). The perceived benefits of reduction in problematic cannulation episodes (4,(6)(7)(8) and patient discomfort and lower requirement for AVF interventions have led to a resurgence in the use of BH cannulation, specifically in the home hemodialysis (HHD) setting (6,7,(9)(10)(11)(12)(13). Recent studies have suggested increased infections in patients using BH cannulation; however, definitive evidence is lacking (8,10,14).…”

Experiência inicial com a técnica de Buttonhole em um centro de hemodiálise Brasileiro

“…[7][8][9][10][11][12][13][14][15] Currently, the introduction of daily hemodialysis and the consequent increase in the number of cannulations per week can represent an additional indication for the BH technique, although some studies have shown that a greater number of cannulations per week does not necessarily relate to a reduction in vascular access survival. 9 Aiming at assessing the usefulness and efficacy of the BH technique in daily clinical practice, a protocol for creating and cannulating AVF according to the BH technique has been introduced in our service.…”