Vascular access Cannulating (puncturing your Ateriovenous Venous Fistula) is among the more difficult aspects of Hemodialysis (HD). However, many patients have discovered that the Buttonhole Technique (using dull needles) can make AV Fistula cannulation more bearable and less painful. Although in the past, the Buttonhole Technique was preferred, recent studies have taken aim at the process. The Clinical Journal of the American Society of Nephrology published a study on January 2014 stating that, "The relative merits of buttonhole (or blunt needle) versus rope ladder (or sharp needle) cannulation for Hemodialysis vascular access are unclear."
Recommended Reading: Suggestions to avoid problems with Buttonhole for CKD Population
Many people find the use of sharp needles to be more painful during treatment than needles that are blunt. Further, many have successfully used the Buttonhole Technique for years without incident. However, the American Society of Nephrology study found that the use of buttonholes in HD patients were associated with a "significantly higher" rate of total Arteriovenous Fistula infections. Hence, many professionals are now recommending discontinuing the Buttonhole Technique for the preferred Rope Ladder Technique.
Recommended Reading: Obstruction in AV Fistula can cause Dialysis Patients to Lose Fingers or even a Hand
The Rope Ladder Technique is the most frequently used cannulation method in the United States and rotates the needle placement sites each time you conduct dialysis. Using this method your needle, which will be sharp, should be 1 1/2 to 2 inches from the last puncture site. It has been found that Rope Ladder can help expand the lifespan of your fistula. Changing cannulation sites give the previous needle site time to heal, prevents aneurysms from forming, and reduces risk of infection.
Recommended Reading: CKD on Dialysis should make checking Fistula "Buzz" a Daily Practice
Still many prefer the buttonhole method because using the same site often is easier and re-sticking with a sharp needle is infrequent. Current buttonhole users had far fewer bruises and infiltrations as well as a decrease in anxiety related to needle placement. Some have noted that by applying Lidocaine cream and removing their scab with needle nose tweezers, rather than "digging it off," they have had fewer infections related to their buttonhole.
Clearly, HD patients are all different so you should discuss with your Nephrologists which cannulation technique is best for you given these new found risks. KidneyBuzz.com is a daily news resource that you can turn to for tailored, breaking news related to dialysis, Chronic Kidney Disease and Diabetes. Support us by purchasing our new Life Management and Diet Guide called Fight Kidney Disease and Diabetes. Without your support and viewership, we could not provide this information to you every day, for that we are both humbled and grateful. Take advantage of the free February Newsletter by signing up at firstname.lastname@example.org, and remember to view each obstacle and set back as an opportunity for you to grow and become more resilient.
Most Popular Stories:
Buttonhole cannulation and clinical outcomes in a home hemodialysis cohort and systematic review., Muir CA, Kotwal SS, Hawley CM, Polkinghorne K, Gallagher MP, Snelling P, Jardine MJ., Clin J Am Soc Nephrol. 2014.
"Believing in the Buttonhole Technique." Http://www.nephrologynews.com/. Nephrology News and Issues.
"Rope Ladder and Constant Site or Buttonhole Techniques." Http://www.davita.com/. DaVita HealthCare Partners Inc.