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• W2520772007 abstract "Buttonhole (or “constant site”) cannulation was first described in the literature in 1977 by Dr. Z. Twardowski. The method was initially utilized in one patient out of necessity due to a very limited area for puncture in the remaining fistula. After utilization of this method in 16 patients for six months during 10,000 dialyses, buttonhole cannulation was found to be a safe and effective method of cannulation. Benefits included easier and quicker needle insertion for dialysis staff, less painful cannulation with the elimination of anesthetic, decrease in “bad sticks,” reduction in hematoma formation, and no increase in infection rates on the patient’s side (Twardowski, 1977). In 1984, Kronung presented data comparing single and repeated fistula punctures, demonstrating that needle puncture causes elongation of the front wall of the fistula due to tissue displacement and filling in of the hole with thrombus. The technique utilized for the puncture determines the consequences experienced. Area puncture technique, which involves cannulating in a circumscribed area, leads to aneurysmatic dilatations and stenoses in adjacent areas. Rope-ladder puncture technique, which involves needle punctures along the length of the fistula, leads to small dilatations over the length but no aneurysmatic dilatations. Constant-site or buttonhole puncture technique causes neither aneurysms nor dilatations; therefore, it claims to be the most advantageous technique (Kronung, 1984). In 2007, Verhallen, Kooistra, and VanJaarsveld compared the rope-ladder technique with the buttonhole method. Their data indicated that the buttonhole method offers an easier cannulation with less “bad sticks;” this benefits patients with limited cannulation sites or with fistulae that are difficult to cannulate. Buttonhole cannulation has gained acceptance, and utilization has increased. A voluntary environmental scan performed by the ESRD Networks in conjunction with the Fistula First Breakthrough Initiative (FFBI) in 14 networks indicated that 33% of the units surveyed were utilizing the buttonhole technique (FFBI, 2007). There have been many anecdotal reports of infections occurring with the buttonhole method related to presumed breaks in cleansing technique. Marticorena (2006) reported that meticulous skin preparation of buttonhole sites is essential. Once established, it is easy for cannulators to become lax and use inadequate skin preparation. This can result in bacteremia and severe clinical sequelae, outcomes that are not commonly expected with conventional cannulation under stringent hygiene conditions. They concluded that the buttonhole technique requires a more stringent protocol of skin preparation before cannulation and after needle removal." @default.
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• W2520772007 date "2008-01-01" @default.
• W2520772007 modified "2023-09-27" @default.
• W2520772007 title "Fistula First: Vascular Access Update Fistula First: Vascular Access Update" @default.
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