Annual Dialysis Conference

Annual Dialysis Conference

February 11, 2020
1 min read

Buttonhole technique seen as effective for patients on home dialysis

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KANSAS CITY, Mo. — The buttonhole technique for vascular access is safe for home hemodialysis as long as patients are diligent about skin preparation and cannulation, clinicians from Fresenius Medical Care reported in a poster presentation.

“Typical home hemodialysis (HHD) patients are the recipients of approximately 10 cannulations/week, 40 needle cannulations/month or 480 cannulations/year. If you consider that fear of needles can affect up to 25% of the adult population, looking for a way to decrease the need for ‘sticking’ a patient with a sharp needle becomes a very welcome alternative,” Peggy Bushey, BSN, RN, CDN, and colleagues from the University of Vermont Medical Center, wrote.

Unlike conventional cannulation of multiple sites on an arteriovenous fistula (AVF), the buttonhole technique involves cannulating the same site of the AVF multiple times. A blunt needle is then used to cannulate the newly created tract.

“Over the past decade, use of buttonhole technique has waxed and waned,” the authors wrote. “Unfortunately, the number of bloodstream infections experienced by patients utilizing this technique has resulted in this technique being banned by many, if not most in-center dialysis programs. Taking a closer look at the pros and cons of this technique warrants our attention.”

The Vermont study group instituted best practices with the center’s home hemodialysis population that included washing the access site before cannulating; eliminating use of pickers or tweezers to remove scabs; and “absolute” compliance with skin preparation and cannulation during the training period.

After 922 days, no patients on home hemodialysis in the study group had an access-related blood-stream infection.

“We identified the importance of strict skin antisepsis and complete removal of the scab by soaking and scrubbing rather than picking prior to insertion of the needle into the tract,” the researchers wrote. “We admit that this is not a viable technique for in-center hemodialysis patients unless they self-cannulate, due to multiple cannulators and the high probability of missed steps or shortcuts. We believe that with enhanced patient education around the preparation of the needle site with emphasis on proper scab removal technique, the buttonhole procedure can be offered as a safe alternative for HHD patients.”


Bushey P, et al. Poster #38. Presented at: The Annual Dialysis Conference; Feb. 8-11, 2020; Kansas City, Missouri.

Disclosures: Bushey and colleagues reported no relevant financial disclosures.