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A simple method to create buttonhole cannulation tracks in a busy hemodialysis unit.

Authors
  • Marticorena, Rosa M
  • Hunter, Joyce
  • Cook, Ramona
  • Kashani, Mina
  • Delacruz, Julia
  • Petershofer, Elizabeth
  • Macleod, Steve
  • Dacouris, Niki
  • McFarlane, Philip A
  • Donnelly, Sandra M
  • Goldstein, Marc B
Type
Published Article
Journal
Hemodialysis international. International Symposium on Home Hemodialysis
Publication Date
Jul 01, 2009
Volume
13
Issue
3
Pages
316–321
Identifiers
DOI: 10.1111/j.1542-4758.2009.00373.x
PMID: 19515069
Source
Medline
License
Unknown

Abstract

The preference for fistulae as the hemodialysis access of choice has led to a significant number of accesses that are less than ideal for cannulation. Buttonhole cannulation is ideal for such accesses, but the technique for creation provides major challenges. In 12 patients, buttonhole tunnel tracks were created by leaving the polyurethane catheter of a Clampcath hemodialysis needle indwelling for 10 days after the initial cannulation. After each dialysis the catheter was flushed, and dressed with an antibacterial ointment and gauze. Dialysis was carried out via the catheter during that time. After day 10, the catheter was removed, the tunnel track covered with an antibacterial dressing and the tunnel track was cannulated with a dull buttonhole needle at the next dialysis. Successful buttonhole accesses were created in 11 patients after 10 days, the 12th patient required a single sharp needle cannulation before using dull needles. During the first 2 weeks of dull needle cannulation both pain experienced on cannulation and the difficulty cannulating the access were significantly less than in the classical buttonhole technique (P<0.01). Complications during the follow-up period (6 months-1.5 years) included difficulty cannulating with a dull needle (22) and antibacterial agent induced contact dermatitis (4). There was no episode of sepsis or tunnel track infection. Initial cannulation of the fistula using a Clampcath hemodialysis needle, leaving the polyurethane catheter indwelling for 10 days, is a simple, safe, and effective technique for the creation of buttonhole tunnel tracks.

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