Buttonhole method home in hemodialysis

What is the buttonhole method home in hemodialysis and why it is used

The conventional method of repeated cannulation of an AVF involves using sharp-tip needles and rotating needle puncture sites (“rope-ladder technique”) with each successive dialysis treatments.

A “buttonhole” is a constant fibrous tract established by repeated puncture followed by small eschar formation of the same site.

Recannulation of the same two sites eventually allows access with a blunt-tip needle.

What are the advantages and disadvantages of buttonholes?

Some observational studies suggest that the buttonhole method helps minimize patient discomfort and adverse effects of repeated cannulation attempts and provides a predictable location for repeated puncture. Buttonholes can allow for greater ease of cannulation by the patient or caregiver. It has also been reported to reduce the pain associated with sharp-needle puncture, although this claim has been disputed with a more recent randomized controlled trial. The primary limitation of buttonhole use is its increased risk of infections. Studies have shown that buttonhole cannulation results in higher rates of both local and systemic infections. In particular, it increases the risk of Staphylococcus aureus bacteremia. The use of the buttonhole technique thus may be more appropriate in some cases, such as for patients with short AVF segments.

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