title: A randomised controlled trial of buttonhole cannulation for the prevention of fistula access complications.
abstract: OBJECTIVE
  This multicentre, prospective, open label, randomised controlled trial was to determine whether buttonhole cannulation technique in new and established haemodialysis fistula reduced complications and prolonged the access life compared to usual practice.
  
  
  METHODS
  Seventy subjects were recruited for this study. Subjects randomised to the buttonhole group had their fistula cannulated by the same staff member for two to four weeks at the same angle and direction with sharp needles. Once the tunnel was developed, blunt needles were used. The control group continued with usual practice (rope ladder rotation technique).
  
  
  RESULTS
  Infection at the cannulation site occurred in four patients in the buttonhole group and one in the rope ladder rotation group (p = 0.11). Haematomas at the cannulation site and site pain experienced during the dialysis session were more often recorded for the buttonhole group (p < 0.05).
  
  
  CONCLUSIONS
  This study showed that buttonhole cannulation resulted more infections, haematoma formation and site pain during dialysis than with the rope ladder rotation group. A further larger scale longitudinal study is recommended.
authors.affiliation: Area Cardiovascular Stream, Sydney South West Area Health Service, Australia. Josephine.Chow@sswahs.nsw.gov.au
authors.forename: Josephine
authors.initials: J
authors.lastname: Chow
authors.forename: Glenda
authors.initials: G
authors.lastname: Rayment
authors.forename: Susana
authors.initials: S
authors.lastname: San Miguel
authors.forename: Margaret
authors.initials: M
authors.lastname: Gilbert
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D001315:Australia; D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*