title: Buttonhole technique better than area puncture technique on hemostasis and pain associated with needle cannulation.
abstract: BACKGROUND
  The buttonhole (constant site) arteriovenous fistulae cannulation technique, in which the inserted needle utilizes exactly the same site and the same angle every dialysis session, offers the advantage of an easier cannulation procedure, less pain associated with cannulation, and fewer complications when compared with the traditional method.
  
  
  OBJECTIVE
  To compare buttonhole arteriovenous fistula (AVF) cannulation technique with area puncture method on the effect of hemostasis after needle withdrawal and pain during needle puncture.
  
  
  METHODS
  The duration of hemostasis after needle withdrawal and pain during needle puncture of AVF were prospectively recorded in 21 chronic hemodialysis patients at Siriraj Hospital. The data that were collected while using area puncture with sharp needle and while using buttonhole with blunt needle were compared by using Paired t-test.
  
  
  RESULTS
  Compared with area puncture method, the duration of hemostasis after needle withdrawal in patients using buttonhole method was significantly shorter in both arterial (4.19 +/- 1.66 mins vs. 9.12 +/- 2.36 mins, p < 0.0001) and venous site (3.92 +/- 1.37 mins vs. 9.12 +/- 2.36 mins, p < 0.0001). The pain score during needle puncture of AVF in patients using buttonhole method was also significantly less than area puncture method in both arterial (1.20 +/- 0.90 vs. 6.03 +/- 0.90, p < 0.0001) and venous site (1.38 +/- 0.75 vs. 5.88 +/- 0.82, p < 0.0001).
  
  
  CONCLUSIONS
  Buttonhole AVF puncture method is a useful technique to reduce both the time for hemostasis after needle withdrawal and pain during needle puncture.
authors.affiliation: Medical Nursing Division, Department of Nursing, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Nuntarat
authors.initials: N
authors.lastname: Sukthinthai
authors.forename: Aporn
authors.initials: A
authors.lastname: Sittipraneet
authors.forename: Banluesak
authors.initials: B
authors.lastname: Tummanittayangkoon
authors.forename: Somkiat
authors.initials: S
authors.lastname: Vasuvattakul
authors.forename: Thawee
authors.initials: T
authors.lastname: Chanchairujira
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D006435:Renal Dialysis