Published research suggests access-related Staphylococcus aureus bacteremia rates were nearly seven-times higher for patients on hemodialysis who were cannulated using the buttonhole needling technique compared with stepladder/area puncture.
“Staphylococcus aureus is the leading cause of bacteremia in [hemodialysis] HD patients and is associated with severe complications such as endocarditis and osteomyelitis,” Rie Glerup, MD, of the department of nephrology at Aalborg University in Denmark, and colleagues wrote. “The pathogen is the main cause of infectious morbidity related to vascular access in HD patients and often causes patient death.”
The researchers argued the possible advantages of buttonhole cannulation — including longer arteriovenous fistula patency and fewer necessary access interventions — have not been “convincingly documented,” with more evidence indicating buttonhole cannulation increases risk of infection.
They conducted a prospective multicenter observational cohort study of 286 patients who received in-center hemodialysis in Denmark (144 cannulated with the buttonhole technique). Primary endpoints of the study were rates of access-related S. aureus bacteremia, as well as the HR for the first access related S. aureus bacteremia with the buttonhole technique compared with the HR for stepladder/area needling.
Patients in the buttonhole group were followed for a mean of 783 days, while those in the stepladder/area group were followed for a mean of 667 days. During follow-up, researchers identified 48 episodes of access-related S. aureus bacteremia. Of these, 43 patients (90%) were in the buttonhole group and five (10%) were in the stepladder/area group. In addition, the HR for the first access-related S. aureus bacteremia was significantly higher for buttonhole cannulation vs. stepladder/area needling (unadjusted HR 6.8; adjusted HR = 8.4)
“The data suggest that it might be advisable to identify and characterize the group of patients suitable for buttonhole cannulation to implement strict selection criteria,” the researchers wrote. “In our HD facilities, buttonhole and stepladder/area cannulation techniques have been equal first choices in in-center HD patients; however, the results question the use of buttonhole cannulation as a first choice. An individual restrictive attitude is recommended, with buttonhole as a second alternative to area technique when stepladder cannulation is not feasible.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.