title: Patients' perspectives of constant-site (buttonhole) cannulation for haemodialysis access.
abstract: BACKGROUND
  The advent of blunt needles for arteriovenous fistula cannulation has led to a resurgence in the buttonhole technique. Although successful for home haemodialysis patients and those who self-cannulate, we introduced this technique into one of our satellite dialysis centres.
  
  
  METHODS
  Audit of buttonhole cannulation in 53 adult haemodialysis patients, 29 male, mean age 68.5 ± 1.9 years. Twelve (23%) patients started de novo and 41 (77%) had previously been using sharp needles with the rope ladder technique.
  
  
  RESULTS
  Typically, the needle tract was developed after 8-10 cannulations depending on the tracker nurse and vessel. Ninety-three percent of the patients reported shorter venepuncture bleeding times after needle removal, 81% less pain on needling and 80% improved appearance of the fistula compared to sharp needle rope ladder technique. Fistula recirculation rates fell from 9.3 ± 0.4 to 8.3 ± 0.3% (p = 0.016), as did fistuloplasty requirement during a median follow-up of 14 months (range, 9.5-22.5; χ(2) = 5.6, p = 0.008).
  
  
  CONCLUSIONS
  Buttonhole cannulation can be successfully introduced into a busy satellite dialysis centre. Patient satisfaction improved due to lower pain scores, shorter bleeding times after needle removal and improved appearance of the fistula. Recirculation rates and requirement for fistuloplasty were also reduced.
authors.affiliation: Barnet Dialysis Centre, Royal Free Hospital, London, UK.
authors.forename: Janice
authors.initials: J
authors.lastname: Ward
authors.forename: Kate
authors.initials: K
authors.lastname: Shaw
authors.forename: Andrew
authors.initials: A
authors.lastname: Davenport
mesh_terms: D000368:Aged; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D005402:Fistula / Q000209:etiology / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009339:Needles / Q000009:adverse effects; D017060:Patient Satisfaction; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*