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Garza B, Geer J, Swartz SJ, Srivaths P, Huynh TTT, Brewer ED. Good outcomes for arteriovenous fistula with buttonhole cannulation for chronic hemodialysis in children and adolescents. Pediatr Nephrol 2023; 38:509-517. [PMID: 35511295 DOI: 10.1007/s00467-022-05580-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/17/2022] [Accepted: 04/07/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Arteriovenous fistula (AVF) is the preferred access for chronic hemodialysis (HD) in children and adolescents, but central venous catheter use is still high. METHODS Retrospective chart review of children and adolescents with AVF created between January 2003 and December 2015 was performed to assess primary failure (PF), maturation time, functional primary and functional cumulative patency, and potential risk factors for AVF dysfunction. RESULTS Ninety-nine AVF were created in 79 patients (54% male; 7-24 years; 16-147 kg) by experienced surgeons. Duplex ultrasonography vein mapping was used to assist with site selection. PF occurred in 17 AVF (17%) in 14 patients. Patient age, gender, ethnicity, underlying disease, time on dialysis, and AVF site were not associated with PF or patency. Coagulation abnormality was positively associated with PF (p = 0.03). Function was achieved in 82 AVF (83%) in 77 patients (97%). Median maturation time was 83 days (range 32-271). AVF were accessed via buttonholes. Functional primary patency was 95%, 84%, and 53% at 1, 2, and 5 years. Overall 1- and 2-year functional cumulative patency was 95%, but lower for small patients 16-30 kg (88%) and those greater than 80 kg (91%). The 5-year patency rate was 80%, but significantly lower for 16-30 kg (59%) and greater than 80 kg (55%). Risk analysis showed significantly better patency for 31-45 kg and 46-80 kg groups (p < 0.01), non-obese BMI (p = 0.01), and buttonhole self-cannulation (p = 0.03). CONCLUSIONS This study provides more information about successful AVF with buttonhole cannulation in pediatric hemodialysis patients lending additional support for AVF use in pediatrics. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Brittany Garza
- Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, TX, USA.
| | - Jessica Geer
- Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, TX, USA
| | - Sarah J Swartz
- Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, TX, USA
| | - Poyyapakkam Srivaths
- Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, TX, USA
| | - Tam T T Huynh
- Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Eileen D Brewer
- Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, TX, USA
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Diop B, Maibe M, Dembele B, Ndoye A, Daffe M, Sane J. Irreducible posterolateral elbow dislocation: A case report. Trauma Case Rep 2022; 42:100709. [PMID: 36210917 PMCID: PMC9535322 DOI: 10.1016/j.tcr.2022.100709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
Elbow dislocations are very common, particularly in the posterolateral variety. Closed reduction is usually easy. However, an irreducible elbow dislocation without associated fracture is rare. We report the case of a 21-year-old patient who presented with an isolated posterolateral irreducible elbow dislocation. Open reduction revealed the buttonhole radial head in the capsule and the complex ligaments. A significant protrusion of the radial head associated with a closed reduction failure is highly suspicious of an irreducible dislocation. Irreducible elbow dislocation without associated fracture is extremely rare. A buttonhole aspect of radial head is characteristic. An enormous radial head protrusion with a reduction failure made the diagnosis.
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Affiliation(s)
- B. Diop
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal,Corresponding author at: Department of Surgery, Gaston Berger University, Ile Sud, Saint Louis, Senegal.
| | - M. Maibe
- Department of Orthopedic Surgery, Cheikh Anta Diop University, Dakar, Senegal
| | - B. Dembele
- Department of Orthopedic Surgery, Cheikh Anta Diop University, Dakar, Senegal
| | - A.Y. Ndoye
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
| | - M. Daffe
- Department of Orthopedic Surgery, Cheikh Anta Diop University, Dakar, Senegal
| | - J.C. Sane
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
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Staaf K, Fernström A, Uhlin F. Cannulation technique and complications in arteriovenous fistulas: a Swedish Renal Registry-based cohort study. BMC Nephrol 2021; 22:256. [PMID: 34233650 PMCID: PMC8265150 DOI: 10.1186/s12882-021-02458-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The four cannulation techniques, rope ladder (RL), area puncture (AP), buttonhole with blunt needles (BHb), and buttonhole with sharp needles (BHs), affects the arteriovenous fistula (AVF) in different ways. The aim of this study was to describe the relationship between the different cannulation techniques and the occurrence of AVF complications. METHODS The study was performed as a national registry-based cohort study using data from the Swedish Renal Registry (SRR). Data were collected from January 2014 to October 2019. Seventy of Sweden's dialysis units participate in the registry. We analyzed a total of 1328 AVFs in this study. The risk of complications was compared between the four different cannulation techniques. The risk of AVF complications was measured by the incidence and incidence rate ratio (IRR). We compared the IRRs of complications between different cannulation techniques. RESULTS BHs is the most common cannulation technique in Sweden. It has been used in 55% of the AVFs at some point during their functional patency. BHb (29%), RL (13%), and AP (3%) has been used less. BHb had the lowest risk of complications compared to the other techniques, and a significantly lower risk of stenosis, infiltration, cannulation difficulties, compared to RL and BHs. Cannulation difficulties were significantly more common using AP compared to BHs, and BHb. Infections were not significantly increased using the buttonhole technique. CONCLUSIONS BHb had the lowest risk of complications. Infections were not significantly increased using the buttonhole technique. Dialysis units with a low infection rate may continue to use the buttonhole technique, as the risk of complications is lower.
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Affiliation(s)
- Karin Staaf
- Department of Nephrology and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85, Linköping, Sweden.
| | - Anders Fernström
- Department of Nephrology and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Fredrik Uhlin
- Department of Nephrology and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85, Linköping, Sweden.,Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
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Affiliation(s)
- Anil K Agarwal
- Division of Nephrology, Department of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
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Hirabayashi KE, Manche EE. Hydrogel sealant to prevent recurrent epithelial ingrowth in the setting of a LASIK flap buttonhole. Am J Ophthalmol Case Rep 2019; 15:100518. [PMID: 31372580 PMCID: PMC6656928 DOI: 10.1016/j.ajoc.2019.100518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 06/14/2019] [Accepted: 07/15/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To report the first case of hydrogel sealant to prevent the recurrence of epithelial ingrowth in a LASIK flap buttonhole. Observations A 67-year-old female presented ten years after undergoing bilateral LASIK with diffuse lamellar keratitis and flap dislodgement after blunt trauma to the right eye. She was found to have epithelial ingrowth with diffuse debris and striae, so her flap was lifted and the epithelial ingrowth was removed. However, a central buttonhole was noted intraoperatively. Once all the epithelium was removed, the flap was repositioned and hydrogel sealant (ReSure, Ocular Therapeutix, Bedford, MA) was used to fill the buttonhole as well as seal down the edges of the flap. Sixteen months postoperatively, the patient's uncorrected visual acuity was 20/50-2 and there was no recurrence of the epithelial ingrowth at the edges of the buttonhole. Conclusions and importance Preventing the recurrence of epithelial ingrowth is a challenging situation, especially in the setting of a LASIK flap buttonhole. The use of hydrogel sealant in the buttonhole and around the edges of the flap may offer an elegant and effective solution.
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Affiliation(s)
- Kristin E Hirabayashi
- Department of Ophthalmology, Stanford University, Byers Eye Institute, 2452 Watson Ct, Palo Alto, CA, 94303, USA
| | - Edward E Manche
- Department of Ophthalmology, Stanford University, Byers Eye Institute, 2452 Watson Ct, Palo Alto, CA, 94303, USA
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Abstract
We devised a method that enables blood removal/return by creating a fistula between the skin and the great saphenous vein to insert the dialysis needle sheath in the femoral vein under ultrasonography guidance with respect to each dialysis. We report the principles, methods, and cases. A skin-great saphenous vein fistula is created under local anesthesia. It is used for blood removal/return during maintenance hemodialysis performed immediately after creating the fistula. Ten limbs of 10 patients (three men and seven women; mean age, 77.6 ± 4.8 years; dialysis history, 9.9 ± 13.0 years), where skin-great saphenous vein fistulas were created in our hospital between May 2017 and June 2018, were included. In all the cases, an arteriovenous fistula or arteriovenous graft was difficult to create because of the general condition and/or vascular fitness of the patients. During or after the fistula-creating surgery, no serious complications were found. No complications such as blood removal failure, infection, or hemorrhage were found during the follow-up period. The primary patency rates by the Kaplan-Meier method were 100% at 3 months and 67.5% at 6 months. This method is considered a valuable substitute method for cases with difficulty in creating a vascular access.
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Huang SHS, MacRae J, Ross D, Imtiaz R, Hollingsworth B, Nesrallah GE, Copland MA, McFarlane PA, Chan CT, Zimmerman D. Buttonhole versus Stepladder Cannulation for Home Hemodialysis: A Multicenter, Randomized, Pilot Trial. Clin J Am Soc Nephrol 2019; 14:403-410. [PMID: 30659057 PMCID: PMC6419275 DOI: 10.2215/cjn.08310718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/12/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Canadian home hemodialysis guidelines highlight the potential differences in complications associated with arteriovenous fistula (AVF) cannulation technique as a research priority. Our primary objective was to determine the feasibility of randomizing patients with ESKD training for home hemodialysis to buttonhole versus stepladder cannulation of the AVF. Secondary objectives included training time, pain with needling, complications, and cost by cannulation technique. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS All patients training for home hemodialysis at seven Canadian hospitals were assessed for eligibility, and demographic information and access type was collected on everyone. Patients who consented to participate were randomized to buttonhole or stepladder cannulation technique. Time to train for home hemodialysis, pain scores on cannulation, and complications over 12 months was recorded. For eligible but not randomized patients, reasons for not participating in the trial were documented. RESULTS Patient recruitment was November 2013 to November 2015. During this time, 158 patients began training for home hemodialysis, and 108 were ineligible for the trial. Diabetes mellitus as a cause of ESKD (31% versus 12%) and central venous catheter use (74% versus 6%) were more common in ineligible patients. Of the 50 eligible patients, 14 patients from four out of seven sites consented to participate in the study (28%). The most common reason for declining to participate was a strong preference for a particular cannulation technique (33%). Patients randomized to buttonhole versus stepladder cannulation required a shorter time to complete home hemodialysis training. We did not observe a reduction in cannulation pain or complications with the buttonhole method. Data linkages for a formal cost analysis were not conducted. CONCLUSIONS We were unable to demonstrate the feasibility of conducting a randomized, controlled trial of buttonhole versus stepladder cannulation in Canada with a sufficient number of patients on home hemodialysis to be able to draw meaningful conclusions.
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Affiliation(s)
- Shih-Han S. Huang
- Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Jennifer MacRae
- Department of Medicine, Division of Nephrology, Foothills Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Dana Ross
- Ottawa Hospital, Ottawa, Ontario, Canada
| | - Rameez Imtiaz
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Brittany Hollingsworth
- Kidney Research Centre of the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gihad E. Nesrallah
- Faculty of Medicine, Division of Nephrology, Humber River Hospital, Toronto, Ontario, Canada
| | - Michael A. Copland
- Department of Medicine, Division of Nephrology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and
| | | | - Christopher T. Chan
- Department of Medicine, Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Deborah Zimmerman
- Ottawa Hospital, Ottawa, Ontario, Canada
- University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
- Kidney Research Centre of the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Baena L, Merino JL, Bueno B, Martín B, Sánchez V, Caserta L, Espejo B, Domínguez P, Gómez A, Paraíso V. Establishment of buttonhole technique as a puncture alternative for arteriovenous fístulas. experience of a centre over 3years. Nefrologia 2017; 37:199-205. [PMID: 28434704 DOI: 10.1016/j.nefro.2016.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/17/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The buttonhole (BH) puncture technique for arteriovenous fistulas is an alternative to the classical staggered puncture. PURPOSE We present 3years' results incorporating the BH puncture technique for arteriovenous fistulas in our dialysis unit. MATERIAL AND METHODS Twenty-two patients were started on BH technique, 15 men and 7 women (mean age: 62 years; SD: 12), with time spent on dialysis when starting the BH technique of 34 months (SD: 34, median: 27, range: 3-136). Seven patients received acenocoumarol and 9 antiplatelet agents. The vascular access median time at the beginning of the technique was 27 months (range: 3-252). RESULTS Between 5 and 8 consecutive dialysis sessions were necessary to achieve a proper tunnel puncture. No patient suffered major complications. The average time on BH technique until December 2015 was 12 months (SD: 10, median: 9, range: 1-45). By the end of the study, 5patients were performing self-puncture. Haemostasis times post-dialysis were reduced from 18.6min (SD: 8, prior to the BH technique), to 12.2minutes (SD: 3 after BH) (P=.0005). CONCLUSIONS The BH technique is an alternative puncture technique for dialysis patients. Self-puncture and reduction in hemostasis time are potential beneficial aspects. A greater diffusion of this technique in the hemodialysis units would allow it to be better applied. A highly motivated nursing staff is key and a necessary condition for its implementation.
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Affiliation(s)
- Laura Baena
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - José L Merino
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España.
| | - Blanca Bueno
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - Beatriz Martín
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - Verónica Sánchez
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - Luca Caserta
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - Beatriz Espejo
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - Patricia Domínguez
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - Alicia Gómez
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - Vicente Paraíso
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
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Hughes M, Frasquet-Garcia A, Ismail M, Waseem M. Skin Entrapment in an Un-displaced Proximal Humerus Fracture Treated with Closed Reduction; A Case Report. Open Orthop J 2016; 10:120-4. [PMID: 27347240 PMCID: PMC4897205 DOI: 10.2174/1874325001610010120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/01/2015] [Accepted: 04/15/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Proximal humerus fractures are a common presentation to Orthopaedic services in the United Kingdom, and the incidence is increasing. Proximal humerus fractures are usually associated with low energy trauma in elderly patients. There is a sub-set of younger patients who suffer low energy fractures due to underlying osteopenia, commonly associated with alcohol excess. Skin puckering or dimpling has been described as a very rare complication of proximal humerus fracture. Based on the few previously published reports of this complication, skin entrapment in proximal humerus fracture is usually predictive of failure of closed reduction, and need for open surgery. Methods: Literature searches were carried out for relevant keywords. Articles were then critically appraised before being included in the literature review. Results: The Authors were only able to identify three previous reports of this rare complication. Conclusion: The authors describe a rare case of skin interposition in an un-displaced proximal humerus fracture, outline a technique for closed reduction, and review the current literature surrounding this rare complication.
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Affiliation(s)
- Michael Hughes
- Trauma & Orthopaedics, Macclesfield District General Hospital, Macclesfield, Cheshire, UK
| | | | - Mobeen Ismail
- Trauma & Orthopaedics, Manchester Royal Infirmary, Manchester, UK
| | - Mohammad Waseem
- Trauma & Orthopaedics, Macclesfield District General Hospital, Macclesfield, Cheshire, UK
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Collier S, Kandil H, Yewnetu E, Cross J, Caplin B, Davenport A. Infection Rates Following Buttonhole Cannulation in Hemodialysis Patients. Ther Apher Dial 2016; 20:476-482. [PMID: 26991535 DOI: 10.1111/1744-9987.12409] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/12/2015] [Accepted: 12/17/2015] [Indexed: 12/23/2022]
Abstract
Arteriovenous fistula (AVF) is the preferred access for hemodialysis (HD). Buttonhole (BH) needling has increased following the introduction of "blunt" fistula needles. Although some reported advantages for BH needling, others have reported increased infection risk. As such we reviewed our center practice, and the effect of both nasal screening and eradication and re-education and training programs. We audited the outcomes of 881 HD patients dialyzed between November 2009 and May 2012, divided into three groups: 175 dialyzing exclusively by central venous catheter (CVC), 478 exclusively by area needling AVF (AVF) and 219 by BH. There were 31 Staphylococcus aureus bacteremias (SABs); 14 (45.2%) dialyzing with CVCs, 12 (38.7%) BH and five (16.1%) AVF. The 30 day mortality rate for SAB was 7.5% with a complication rate of 22.6%. The hazard ratio for first SAB was significantly greater for both CVC and BH access compared to AVF (5.3 (95% CI -1.9-18.6), P < 0.001 and 3.6 (1.3-96), P = 0.011, respectively). During the study SAB rates per 1000 CVC days were 0.21, compared to 0.15 for BH. After major re-education and asepsis technique campaigns the SAB rate for BH fell to 0.06, but quickly returned to 0.17. Extending BH needling to all our dialysis centers, SAB infection rates increased to those not dissimilar to CVC access. Despite re-education programs coupled with a strict asepsis policy and active SA eradication, followed by audit cycles, the increased infection risk with BH remained, such that we have limited BH to self-care patients.
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Affiliation(s)
| | - Hala Kandil
- Department of Microbiology, Royal Free Hospital
| | | | - Jennifer Cross
- UCL Centre for Nephrology, Royal Free Hospital, London, UK
| | - Ben Caplin
- UCL Centre for Nephrology, Royal Free Hospital, London, UK
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Abstract
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.
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Affiliation(s)
- Wendy Smyth
- Tropical Health Research Unit for Nursing and Midwifery Practice, Townsville Hospital and Health Service, Townsville, Queensland, Australia.
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