title: Buttonhole Cannulation Is Not Associated with More AVF Infections in a Low-Care Satellite Dialysis Unit: A Long-Term Longitudinal Study.
abstract: BACKGROUND
  Buttonhole cannulation (BHC) has been associated with a greater risk of arteriovenous fistula (AVF)-related infections and septicemia than the rope ladder cannulation (RLC) in in-center hemodialysis (HD). Such infections have never been studied in satellite HD units.
  
  
  METHODS
  Retrospective single center study.
  
  
  METHODS
  All patients in our satellite HD unit using a native AVF from 1 January, 1990, to 31 December, 2012.
  
  
  METHODS
  Two different kinds of cannulation have been used during the study period: From 1 January, 1990 to 1, January, 1998 RLC was used in the unit (period 1). After 1 January, 1998 onwards, all the patients were switched within 3 months to BHC (period 2).
  
  
  RESULTS
  Three different infectious events were observed during the two periods: local AVF infection, bacteremia, and combined infection. The aim of this study was to evaluate the incidence of AVF-related infections in our low-care HD unit and to determine whether BHC is associated with an increased risk of infection in this population.
  
  
  RESULTS
  162 patients were analyzed; 68 patients participated to period 1 and 115 to period 2. Sixteen infectious events occurred. Incidences of AVF-related infectious events were 0.05 [95% CI, 0.02-0.16] and 0.13/1000 AVF-days [95% CI, 0.0.8-0.23], for period 1 and 2 (p = 0.44) respectively. Recurrence of AVF-related infection was observed only during period 2. Unadjusted incidence rate ratio (IRR) of all infections was 0.39 (95%CI 0.12-1.37). Two complicated infections occurred during the study period: one in period 1 and one in period 2.
  
  
  CONCLUSIONS
  Observational retrospective single centre study.
  
  
  CONCLUSIONS
  BHC is not associated with an increased infectious incidence in our HD population from a satellite dialysis unit. In the rare patients with AVF-related infection it seems necessary to change cannulation sites as recurrence of infection might be an event more frequent with BHC.
authors.affiliation: Nephrology, CHU Clemenceau, Caen Cedex, France.
authors.forename: Clémence
authors.initials: C
authors.lastname: Béchade
authors.affiliation: Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Tony
authors.initials: T
authors.lastname: Goovaerts
authors.affiliation: Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Cougnet
authors.affiliation: Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Laura
authors.initials: L
authors.lastname: Labriola
authors.affiliation: Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: Jadoul
authors.affiliation: Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Goffin
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002404:Catheterization; D002408:Catheters, Indwelling / Q000382:microbiology; D003151:Community Health Centers; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies