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.

Dias TS, Moysés Neto M, da Costa JA: Arterio-venous fistula puncture: an essential factor for haemodialysis efficiency. Ren Fail 2008;30:870–876.
Van Waeleghem JP, Elseviers M, De Vos JY, Research Board of EDTNA/ERCA: EDTNA/ERCA vascular access recommendations for nephrology nurses. EDTNA ERCA J 2004;30:97–105.
Twardowski Z, Lebek R, Kubara H: Six-year experience with the creation and use of internal AVF in patients treated with repeated haemodialysis. Pol Arch Med Wewn 1977;57:205–214.
Ball LK: The buttonhole technique for arteriovenous fistula cannulation. Nephrol Nurs J 2006;33:299–304.
Lee T, Barker J, Allon M: Needle infiltration of arteriovenous fistulae in haemodialysis: risk factors and consequences. Am J Kidney Dis 2006;47:1020–1026.
van Loon MM, Kessel AG, van der Sande FM, Tordoir JH: Cannulation practice patterns in haemodialysis vascular access: predictors for unsuccessful cannulation. J Ren Care 2009;35:82–89.
Marticorena RM, Hunter J, Macleod S, Petershofer E, Dacouris N, Donnelly S, Goldstein MB: The salvage of aneurysmal fistulae utilizing a modified buttonhole cannulation technique and multiple cannulators. Hemodial Int 2006;10:193–200.
Pipkin M, Craft V, Spencer M, Lockridge RS Jr: Six years of experience with nightly home hemodialysis access. Hemodial Int 2004;8:349–353.
Doss S, Schiller B, Moran J: Buttonhole cannulation – an unexpected outcome. Nephrol Nurs J 2008;35:417–419.
Davenport A: Low-molecular-weight heparin as an alternative anticoagulant to unfractionated heparin for routine outpatient haemodialysis treatments. Nephrology (Carlton) 2009;14:455–461.
Van Loon MM, Goovaerts T, Kessels AGH, Van der Sande FM, Tordoir JHM: Buttonhole needling of haemodialysis arteriovenous fistulae results in less complications and interventions compared to the rope ladder technique. Nephrol Dial Transplant 2010;25:225–230.
Verhallen AM, Kooistra MP, van Jaarveld BC: Cannulating in haemodialysis: rope ladder or button hole technique ? Nephrol Dial Transplant 2002;22:2601–2604.
Twardowski ZJ: Constant site (button hole) method of needle insertion for haemodialysis. Dial Transplant 1995;24:559–560.
Twardowski Z, Kubara H: Different sites versus constant site of needle insertion into arteriovenous fistulas for treatment by repeated dialysis. Dial Transplant 1979;8:978–980.
Toma S, Shinzatio T: Evaluation of buttonhole puncturing with a dull haemodialysis needle. Kidney Dial 2002;53(suppl):174–176.
Konner K, Nonnast-Daniel B, Ritz E: The arteriovenous fistula. J Am Soc Nephrol 2003;14:1669–1680.
Murcutt G: Buttonhole cannulation: should this become the default technique for dialysis patients with native fistulas? Summary of the EDTNA/ERCA Journal Club discussion Autumn 2007. J Ren Care 2008;34:101–108.
Marticorena RM, Hunter J, Cook R, Kashani M, Delacruz J, Petershofer E, Macleod S, Dacouris N, McFarlane PA, Donnelly SM, Goldstein MB: A simple method to create buttonhole cannulation tracks in a busy hemodialysis unit. Hemodial Int 2009;13:316–321.
Toma S, Shinzato T, Fukui H, Nakai S, Miwa M, Takai I, Maeda K: A time saving method to create a fixed puncture route for the buttonhole technique. Nephrol Dial Transplant 2003;18:2118–2121.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.