Outcomes of buttonhole and rope-ladder cannulation techniques in a tropical renal service

摘要

Background: Buttonhole cannulation was introduced into this Queensland Renal Service in 2005. Contrary to published literature, a local review of cannulation outcomes found no greater likelihood of infections with the buttonhole technique. Objectives: To compare the outcomes of buttonhole and rope-ladder cannulation techniques. Design: Prospective cohort. Participants: Consenting patients attending for haemodialysis via an existing arteriovenous fistula (n=104). Measurements: Cannulation sites were assessed at every dialysis session for 12 weeks; fear and pain were scored by participants weekly. Results: No statistically significant differences in infection, haematoma formation, pain or fear between the techniques. Occurrence of aneurysm was higher (p<0.05) in the rope-ladder group. More patients in buttonhole group required multiple cannulation attempts (p<0.05). More of the rope-ladder group failed to attend their scheduled dialysis sessions (p<0.05). Conclusions and applications to practice: This study confirms that in this setting there are few negative outcomes of either technique of fistula cannulation. Specifically, buttonhole cannulation appears to be a safe alternative means of fistula access to the gold-standard cannulation technique. The Service is examining strategies to improve attendance.