Abstract
BackgroundButtonhole cannulation (BHC) has been associated with a greater risk of arteriovenous fistula (AVF)-related infections and septicemia than the rope ladder cannulation (RLC) in in-center hemodialysis (HD). Such infections have never been studied in satellite HD units.Study DesignRetrospective single center study.Setting and ParticipantAll patients in our satellite HD unit using a native AVF from 1 January, 1990, to 31 December, 2012.Study PeriodTwo different kinds of cannulation have been used during the study period: From 1 January, 1990 to 1, January, 1998 RLC was used in the unit (period 1). After 1 January, 1998 onwards, all the patients were switched within 3 months to BHC (period 2).OutcomesThree different infectious events were observed during the two periods: local AVF infection, bacteremia, and combined infection. The aim of this study was to evaluate the incidence of AVF-related infections in our low-care HD unit and to determine whether BHC is associated with an increased risk of infection in this population.Results162 patients were analyzed; 68 patients participated to period 1 and 115 to period 2. Sixteen infectious events occurred. Incidences of AVF-related infectious events were 0.05 [95% CI, 0.02–0.16] and 0.13/1000 AVF-days [95% CI, 0.0.8–0.23], for period 1 and 2 (p = 0.44) respectively. Recurrence of AVF-related infection was observed only during period 2. Unadjusted incidence rate ratio (IRR) of all infections was 0.39 (95%CI 0.12–1.37). Two complicated infections occurred during the study period: one in period 1 and one in period 2.LimitationsObservational retrospective single centre studyConclusionsBHC is not associated with an increased infectious incidence in our HD population from a satellite dialysis unit. In the rare patients with AVF-related infection it seems necessary to change cannulation sites as recurrence of infection might be an event more frequent with BHC.
Highlights
Buttonhole cannulation (BHC) of an arteriovenous fistula (AVF) was described in 1977 by Twardowski [1]
BHC is not associated with an increased infectious incidence in our HD population from a satellite dialysis unit
BHC has been associated with a higher incidence rate of AVF-related infections and septicemia than the rope ladder technique [2, 6,7]
Summary
Buttonhole cannulation (BHC) of an arteriovenous fistula (AVF) was described in 1977 by Twardowski [1]. Careful disinfection and withdrawal of the scabs formed at the cannulation site are needed, and the track formed is used to guide the needle to access the vessel. This technique is associated with less AVF hematoma [2] and aneurysms’ growth [3]. Buttonhole cannulation (BHC) has been associated with a greater risk of arteriovenous fistula (AVF)-related infections and septicemia than the rope ladder cannulation (RLC) in incenter hemodialysis (HD). Such infections have never been studied in satellite HD units.
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