March 25, 2020
1 min read

Buttonhole cannulation associated with higher risk for vascular access infection

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Meghan Lyman

Buttonhole cannulation is associated with a higher risk for vascular access-related infection than rope-ladder cannulation in patients on in-center hemodialysis, according to a published study.

“We found that [buttonhole cannulation] BHC was associated with higher rates and increased risk for vascular access infections,” Meghan Lyman, MD, medical officer at the CDC, told Healio. She added, “Clinicians and patients should take into account the increased risk for infection associated with BHC when deciding on cannulation method.”

Researchers collected National Healthcare Safety Network national surveillance data to evaluate the risk of infection and burden among patients on in-center hemodialysis with arterio-venous fistulas (AVFs) who used buttonhole cannulation. Each dialysis center that participated completed an annual survey about facility characteristics, buttonhole cannulation questions and infection control practices and procedures.

Between 2013 and 2014, the frequency of patient demographics, vascular access types present, time from AVF placement to event, clinical symptoms and associated outcomes for access-related bloodstream infections compared to pathogen frequency of buttonhole cannulation events and rope-ladder cannulation were examined. Rates of access-related bloodstream infections, local access-site infections and IV antimicrobial starts were compared between buttonhole and rope-ladder cannulations.

A total of 2,466 access-related bloodstream infections, 3,169 local access-site infections and 13,726 IV antimicrobial starts occurred among buttonhole cannulation patients. In those with access-related bloodstream infections, hospitalization due to the event was common (37%) and Staphylococcus aureus was the most common pathogen (52%). Buttonhole cannulation was associated with a significantly higher risk for access-related bloodstream infection and local access-site infection in patients on in-center hemodialysis.

“Additional studies may be needed to evaluate the impact of infection prevention and control interventions on infections associated with BHC, including techniques for skin antisepsis,” Lyman said. – by Erin T. Welsh

Disclosures: The authors report no relevant financial disclosures.