title: Hemodialysis patients' experience with and attitudes toward the buttonhole technique for arteriovenous fistula cannulation.
abstract: BACKGROUND
  the buttonhole technique for arteriovenous fistula cannulation has been recommended as an alternative to the rope ladder technique.
  
  
  OBJECTIVE
  we compared patients' experiences and hypothesized that patients would prefer the buttonhole technique.
  
  
  METHODS
  in an observational cross-sectional study using a 23-item questionnaire, we surveyed hemodialysis patients at 3 dialysis centers who had previously used the rope ladder technique and were presently using the buttonhole technique for their experiences with and attitudes toward the two techniques. Twelve months later, patients' attitudes were reassessed.
  
  
  RESULTS
  26 patients met inclusion criteria. On a scale of 0 (not at all satisfied) to 10 (very satisfied), patients reported a mean satisfaction with the buttonhole technique of 8.5 ± 1.9. 96% of patients said they would recommend it, and 83% reported that the buttonhole technique was easier for the nurses to use. Fewer patients reported fistula infiltration with the buttonhole technique (12% vs. 59%, p = 0.008). Twelve months later, 18 of 23 patients (78%) still dialyzing in the study units remained satisfied with the buttonhole technique.
  
  
  CONCLUSIONS
  patients reported a high level of satisfaction, fewer complications, and a positive attitude about suggesting the buttonhole technique to other patients. Our findings support the recommendation for its more widespread use.
authors.affiliation: Section of Nephrology, Department of Medicine, West Virginia University School of Medicine, WV 26506-9022, USA.
authors.forename: A
authors.initials: A
authors.lastname: Hashmi
authors.forename: M Q
authors.initials: MQ
authors.lastname: Cheema
authors.forename: A H
authors.initials: AH
authors.lastname: Moss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D006435:Renal Dialysis; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014903:West Virginia