title: Initial experience with the buttonhole technique in a Brazilian hemodialysis center.
abstract: BACKGROUND
  The most commonly used technique of arteriovenous fistula cannulation for hemodialysis is the rope-ladder technique with alternation of the cannulation site. An alternative technique, the buttonhole (BH) technique, has become popular because its constant cannulation sites are advantageous for patients with special characteristics.
  
  
  OBJECTIVE
  To assess the initial experience of our service with the BH technique and determine its usefulness.
  
  
  METHODS
  Twenty-one patients with short, tortuous, painful fistulae of difficult cannulation were submitted to the BH technique for the first time using appropriate needles.
  
  
  RESULTS
  Neither bleeding nor hematoma were observed during or after hemodialysis. Some patients (15%) reported little or no pain. Two (9.5%) arteriovenous fistulae were lost, and 47.6% of the patients developed fistula clotting at some point in the study, both situations related to change in cannulators. One patient had a paravertebral abscess, possibly originating from the arteriovenous fistula.
  
  
  CONCLUSIONS
  The advantages of reducing pain, miscannulation, and hematoma incidence were counterbalanced by an increased risk of infection and loss of vascular access, due to noncompliance with the technique or involvement of more than one cannulator. The BH technique is useful for selected patients.
authors.affiliation: Instituto do Rim de Marília, Santa Casa de Misericórdia de Marília, São Paulo, Brazil. enfermagem@rimmarilia.com.br
authors.forename: Geni Dos Santos Teles
authors.initials: Gdos S
authors.lastname: Silva
authors.forename: Roseli Amaro da
authors.initials: RA
authors.lastname: Silva
authors.forename: Alessandra Membrides
authors.initials: AM
authors.lastname: Nicolino
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Pavanetti
authors.forename: Vitor Luiz
authors.initials: VL
authors.lastname: Alasmar
authors.forename: Roberto
authors.initials: R
authors.lastname: Guzzardi
authors.forename: Maurício Braz
authors.initials: MB
authors.lastname: Zanolli
authors.forename: José Cícero
authors.initials: JC
authors.lastname: Guilhen
authors.forename: Ivan de Melo
authors.initials: Ide M
authors.lastname: Araújo
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001938:Brazil; D002404:Catheterization / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*