Abstract
Arteriovenous fistula (AVF) is a “life-line” for hemodialysis patients. Complications associated with AVF cannulation including the occurrence of vessel stenosis and formation of false aneurysms can substantially shorten the length of AVF survival and its utilization. To minimize the damages to vessel walls of AVF, various needling techniques involving the utilization of sharp or blunt needles, and rotating puncture sites are applied in clinical practice. The buttonhole cannulation (BHC) method appears to be a successful technique to solve the problem of puncturing difficult AVFs. However, it is controversial whether BHC should be extended widely to actual practice to generate further beneficial effects or be restricted in clinical use due to a higher risk of adverse AVF complications. This review reports and elaborates on the methods used to create BHC tunnels, the effects of BHC on patient outcomes compared with other cannulation techniques with regard to both objective and subjective aspects, the advantages and disadvantages of BHC, and the measures for improving BHC. According to the published literature, utilizing BHC for AVF cannulation can effectively prevent the complications associated with AVF, while formulating and implementing the standardized BHC procedure, together with comprehensive staff training and self-management education for patients, can substantially reduce the risk of infection. Future studies with rigorous design need to investigate the long-term effects and strengthen the existing evidence regarding the utilization of BHC.
Highlights
Arteriovenous fistula (AVF) is a “life-line” for hemodialysis patients. Traditional cannulation methods, such as the utilization of sharp needles and frequent changes of needling sites and puncturing angles, can inevitably cause massive damage to the walls of a vessel. This can lead to vascular stenosis or to the formation of false aneurysms, which would substantially shorten the length of AVF survival and its utilization
Nesrallah and colleagues reported that the occurrence of staphylococcus aureus infection and its dissemination was significantly associated with the utilization of buttonhole puncture cannulation (BHC) among home dialysis patients [28]
The results indicated that the rate of AVF infection among the BHC group was 52.0% (4/7.7 patient year), which was more than10-fold that in the other group (4.9%, 2/40.7 patient year)
Summary
Arteriovenous fistula (AVF) is a “life-line” for hemodialysis patients Traditional cannulation methods, such as the utilization of sharp needles and frequent changes of needling sites and puncturing angles, can inevitably cause massive damage to the walls of a vessel. This can lead to vascular stenosis or to the formation of false aneurysms, which would substantially shorten the length of AVF survival and its utilization. Some studies have reported that BHC is associated with a higher risk of local or systemic infections, and have recommended that its extensive application among hemodialysis patients should be restricted [2,3]. The purpose of this review was to summarize the various current applications of BHC, the advantages and disadvantages of BHC, and the measures that have been made to improve BHC
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