Con: buttonhole cannulation of arteriovenous fistulae

Nadeau-Fredette, Annie-Claire and Johnson, David W. (2016) Con: buttonhole cannulation of arteriovenous fistulae. Nephrology Dialysis Transplantation, 31 4: 525-528. doi:10.1093/ndt/gfw030

Author Nadeau-Fredette, Annie-Claire
Johnson, David W.
Title Con: buttonhole cannulation of arteriovenous fistulae
Journal name Nephrology Dialysis Transplantation   Check publisher's open access policy
ISSN 1460-2385
Publication date 2016-04-01
Year available 2016
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1093/ndt/gfw030
Open Access Status Not Open Access
Volume 31
Issue 4
Start page 525
End page 528
Total pages 4
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Subject 2727 Nephrology
2747 Transplantation
Abstract Successful cannulation of arteriovenous fistulas (AVFs) using a safe and effective technique that minimizes patient harm is a crucial aspect of haemodialysis treatment. Although the current standard of care for many years has been the rope-ladder technique (using sharp needles to cannulate rotating sites across the entire AVF), a number of enthusiasts have recently advocated for the alternative method of buttonhole cannulation (using blunt needles to repeatedly cannulate the same site via a healed track) on the basis of putative, as yet unproven benefits. In this article, we review all available observational studies, randomized controlled trials, and systematic reviews and meta-analyses that have compared the clinical outcomes of buttonhole and rope-ladder cannulation of AVFs. These studies clearly and consistently demonstrated that buttonhole cannulation causes significant and serious infectious harm to haemodialysis patients, especially in the home setting. No strategies or treatments have been proven to effectively mitigate this hazard of buttonhole cannulation. Moreover, buttonhole cannulation is associated with a higher rate of abandonment and has not been shown to have any proven benefit compared with the rope-ladder method. Specifically, buttonhole cannulation has not been shown to reduce cannulation-related pain, improve vascular access survival, reduce vascular access interventions, reduce haematoma formation, improve haemostasis or reduce aneurysm formation. Consequently, rope-ladder cannulation should remain the standard of care and buttonhole cannulation should only be used in rare circumstances (e.g. short segment AVFs where the only alternative is a haemodialysis catheter)
Keyword Arteriovenous fistula
End-stage renal disease
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
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