Patients’ Perspectives of Constant-Site (Buttonhole) Cannulation for Haemodialysis Access

Abstract

Introduction: The advent of blunt needles for arteriovenous fistula cannulation has led to a resurgence in the buttonhole technique. Although successful for home haemodialysis patients and those who self-cannulate, we introduced this technique into one of our satellite dialysis centres. Methods: Audit of buttonhole cannulation in 53 adult haemodialysis patients, 29 male, mean age 68.5 ± 1.9 years. Twelve (23%) patients started de novo and 41 (77%) had previously been using sharp needles with the rope ladder technique. Results: Typically, the needle tract was developed after 8–10 cannulations depending on the tracker nurse and vessel. Ninety-three percent of the patients reported shorter venepuncture bleeding times after needle removal, 81% less pain on needling and 80% improved appearance of the fistula compared to sharp needle rope ladder technique. Fistula recirculation rates fell from 9.3 ± 0.4 to 8.3 ± 0.3% (p = 0.016), as did fistuloplasty requirement during a median follow-up of 14 months (range, 9.5–22.5; χ² = 5.6, p = 0.008). Conclusions: Buttonhole cannulation can be successfully introduced into a busy satellite dialysis centre. Patient satisfaction improved due to lower pain scores, shorter bleeding times after needle removal and improved appearance of the fistula. Recirculation rates and requirement for fistuloplasty were also reduced.

How to Overcome Barriers and Establish a Successful Home HD Program

“…Patient acceptance of self-cannulation can be enhanced with use of the buttonhole technique, which uses the same needle entry point with the same entry angle. Buttonholes have been associated with 93% shorter bleeding time, 81% less pain, and 80% improved look of the fistula compared with rope ladder technique (91). However, there is a potential for higher infection risk (90).…”

Management Strategies for Pain Associated with Arteriovenous Fistula Cannulation: An Integrative Literature Review

“…The studies included in the review were published between 2004 and 2019. 8,[12][13][14][15][16][17]19,20,22,24,[26][27][28]30,[32][33][34][40][41][42]44 The reviewed literature indicated that the majority of patients being dialyzed using arteriovenous fistulas or grafts reported a moderate degree of cannulation pain. The designs of the selected studies were randomized controlled trials (n = 14; 40%), 5,10,18,21,23,25,[29][30][31][35][36][37][38][39] and observational studies (n = 21; 60%).…”

“…No studies were found prior to 2004. In 66% (n = 23) of the reviewed articles a visual analog scale (VAS) was used to assess pain, 5,8,10,12,[14][15][16][17][18][19][20][21][22][23]30,32,34,[36][37][38][39]42,44 while in 22% (n = 8) a numerical rating scale (NRS) was used 13,24,25,29,31,35,40,41 ; three studies (8%) used the Wong-Baker scale, 26,27,33 and one study (3%) used a structured interview questionnaire and a subjective pain assessment tool. 8,[12][13][14][15][16][17]19,20,22,24,[26][27][28]30,[32]…”

“…16 Another strategy that was tried was the use of markedly cooling fistula needles prior to insertion: The needles were cooled to −8 C prior to cannulation. [12][13][14][15][17][18][19][20][21][22] Rope-ladder technique is considered to be the standard cannulation technique. 32 Other studies assessed the use of the buttonhole cannulation technique (dull needle, exactly same insertion site used) as an alternative to the rope-ladder technique to reduce cannulation side effects.…”

Frequent Hemodialysis Fistula Infectious Complications

“…This ‘constant-site’ method is recommended by some to prevent the development of aneurysms and stenosis which sometimes occur with stepladder cannulation if the cannulation area becomes restricted [15,16,17]. Additional advantages of buttonhole cannulation are purported to include improved ease and speed of cannulation with fewer ‘missed sticks’, less pain, fewer hematomas and aneurysms as well as faster hemostasis after needle removal [18,19,20,21,22,23]. In addition, buttonhole cannulation may be preferred by self-cannulators (particularly for home hemodialysis) and when there are limited viable cannulation sites [15,18].…”