The buttonhole technique for fistula cannulation: pros and cons

The most common method of arteriovenous fistula (AVF) cannulation is the standard rope-ladder technique. An alternative needling possibility is the buttonhole technique (BHT), by which needles are inserted exactly at the same position. Although earlier studies associated the BHT with a reduction in pain and hematoma formation, more recent randomized studies show no reduction in pain and an increased risk of local and systemic infection. However 1 trial with a follow-up of up to 1-year showed a better survival of the AVFs with the BHT, and did not confirm the increased risk of infection in the BHT group. The abovementioned study is the first well-constructed randomized clinical trial that directly compares the BHT with the use of BioHole peg, helping the development of the fibrous tract, and the rope-ladder cannulation techniques.In any case, the successful implementation of the BHT requires the dialysis nurse to develop a high level of knowledge and several specific skills; it also requires frequent monit...