title: Effect of buttonhole cannulation with a polycarbonate PEG on in-center hemodialysis fistula outcomes: a randomized controlled trial.
abstract: BACKGROUND
  Quality improvement strategies to increase and maintain the numbers of arteriovenous fistulas (AVFs) are a critical drive in enhancing the quality of care of patients receiving treatment with hemodialysis. How the AVF is needled is an important consideration in AVF survival; the ideal cannulation technique has not been established to date.
  
  
  METHODS
  Prospective randomized single-center trial.
  
  
  METHODS
  Patients on maintenance hemodialysis therapy (N = 140).
  
  
  METHODS
  A 1-year intervention of buttonhole (constant site) or usual-practice (different site) cannulation.
  
  
  RESULTS
  Primary study outcome was AVF survival over 1 year, in which AVF failure was defined as an AVF no longer used for hemodialysis (also referred to as assisted patency). Secondary outcomes included primary patency, number of access interventions, bleeding time, infection rate, cannulation time and pain, and aneurysm formation.
  
  
  RESULTS
  Demographic data were similar for both groups. The primary outcome measure of AVF survival at 1 year was statistically significantly increased in the buttonhole group (100% vs 86% with usual practice; P = 0.005, log-rank test). In the buttonhole group, there were fewer interventions (19% vs 39% in usual practice) and less existing aneurysm enlargement (23% vs 67% in usual practice). There were no bacteremia events in the buttonhole group and 2 in the usual-practice group (0.09/1,000 AVF days). There were no significant differences in bleeding times and lignocaine use between the 2 groups.
  
  
  CONCLUSIONS
  A single-center study, lack of blinding.
  
  
  CONCLUSIONS
  In this study, AVF survival was significantly greater when using buttonhole cannulation. The buttonhole technique significantly decreased the need for access interventions and reduced existing aneurysm enlargement. Concerns of increased infection rates or prolonged bleeding times with the buttonhole technique were not seen in this study. The buttonhole technique should be considered the cannulation technique of choice for AVFs.
authors.affiliation: Renal Unit, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom. emma.vaux@royalberkshire.nhs.uk
authors.forename: Emma
authors.initials: E
authors.lastname: Vaux
authors.forename: Jennie
authors.initials: J
authors.lastname: King
authors.forename: Swee
authors.initials: S
authors.lastname: Lloyd
authors.forename: Jane
authors.initials: J
authors.lastname: Moore
authors.forename: Leo
authors.initials: L
authors.lastname: Bailey
authors.forename: Isabel
authors.initials: I
authors.lastname: Reading
authors.forename: Ramesh
authors.initials: R
authors.lastname: Naik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D002408:Catheters, Indwelling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011076:Polycarboxylate Cement / Q000627:therapeutic use; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D011076:Polycarboxylate Cement; C005506:polycarbonate; D011092:Polyethylene Glycols