Clinical Utility of the Buttonhole Technique Using Biohole™ in Hemodialysis Patients

Abstract

Background/Aims: Buttonhole cannulation has been popular because it provides an easy puncture, is less painful, and requires less time for hemostasis. However, the technique requires a skilled staff and a long time to form the tract. A new buttonhole technique using Biohole(TM), which shortens the time needed for tract formation, has been introduced in Europe, North America, and Japan. Methods: We prepared a cannulation tract using the buttonhole technique and Biohole(TM) over a two-week period and compared the 12-week outcomes between patients who underwent the rope-ladder versus buttonhole techniques. Results: The 40 patients (27 males) had a mean age of 49.1±14.2 years. Thirteen and 27 patients were cannulated with the rope-ladder and buttonhole techniques, respectively. Patients who underwent the buttonhole technique had more initial pain than did those who received the rope-ladder technique (p=0.044). The Biohole(TM) procedure improved puncture pain (5.6 vs. 3.4, p=0.003) and shortened hemostasis time (1.8 vs. 1.3, p=0.001). Over a two-week period, patients using Biohole(TM) experienced dislocation (20.8%), bleeding at peg sites (8.6%), and pain during peg change (2.4%). Over the 12 week study period, patients who underwent the buttonhole technique had insignificantly less pain than did those who received the rope-ladder technique (p=0.088), but the former had less bleeding time than the latter (p=0.000). One patient who received the buttonhole technique experienced one episode of infection (p=0.327). Conclusions: The new buttonhole technique using Biohole(TM) is safe and useful in the short term. A long-term, larger, multicenter study is required to confirm these results. (Korean J Med 2012;82:307-312)