Buttonhole Method
In my ward, I have an experience of creating a track for buttonhole method which turned out to be successful. Buttonhole technique was initially used in Europe with people who had restricted cannulation sites. In this technique, the needle is implanted accurately at the same site and the same angle for every dialysis session. (Twardowski & Kubara, 1979). Formerly cannulation is mandatory with sharp needles to create a track formation. Ideally, the same person must cannulate the fistula to create the track and keep other staff away to cannulate the same site to condense the risk of malformation of track (Ball, 2006). From my own practice, I have encountered one of the main factor for the cause of infiltration is poor cannulation method. Also,
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Adequate cannulation technique is vital to maintaining life of the fistula and reduces access-related complications. The benefits of buttonhole method in terms of reduction of haematoma, aneurysm formation, diminished pain and the need for interventions. There is an increased conviction that compared with other needling techniques. buttonhole method has several advantages such as lower access related complications; in addition, it is also suitable for self-cannulation patients. In my unit, our nephrologist suggests every patient should go for buttonhole technique because no aneurysm is documented, however, majority of the patients are not willing to go for this procedure perhaps due to lack of knowledge on the benefits and procedure. Currently, there is only 1 patient in our unit who is willing to do self-needling and they are very satisfied with buttonhole method. A prospective study reported reduction of pain in buttonhole cannulation compared with rope-ladder technique although it was not statistically significant, patients commented a greater satisfaction with buttonhole technique(Figueiredo et al.,2008). The buttonhole technique is not suitable for arteriovenous graft (AVG) patients. In addition infections are more found in buttonhole compared to rope ladder with AVF but there is no proof for the use of buttonhole method must be disconnected as well as shortage on evidence for time period of antibiotic treatment for AVF infections. However 6 weeks session has been recommended. National Kidney Foundation KDOQI
Adequate cannulation technique is vital to maintaining life of the fistula and reduces access-related complications. The benefits of buttonhole method in terms of reduction of haematoma, aneurysm formation, diminished pain and the need for interventions. There is an increased conviction that compared with other needling techniques. buttonhole method has several advantages such as lower access related complications; in addition, it is also suitable for self-cannulation patients. In my unit, our nephrologist suggests every patient should go for buttonhole technique because no aneurysm is documented, however, majority of the patients are not willing to go for this procedure perhaps due to lack of knowledge on the benefits and procedure. Currently, there is only 1 patient in our unit who is willing to do self-needling and they are very satisfied with buttonhole method. A prospective study reported reduction of pain in buttonhole cannulation compared with rope-ladder technique although it was not statistically significant, patients commented a greater satisfaction with buttonhole technique(Figueiredo et al.,2008). The buttonhole technique is not suitable for arteriovenous graft (AVG) patients. In addition infections are more found in buttonhole compared to rope ladder with AVF but there is no proof for the use of buttonhole method must be disconnected as well as shortage on evidence for time period of antibiotic treatment for AVF infections. However 6 weeks session has been recommended. National Kidney Foundation KDOQI