I am looking for information on the buttonhole technique of cannulation for AVF. I saw a presentation on it at the PD Conference in Charlotte last winter. I can't find much in journals or text books. Is anyone using this technique out there ? If so can you tell me about your experience with it ? Where can I get more information on it ? I am the Nurse Trainer for a Home Hemo Program and think this is a good cannulation option for my patients. My physician doesn't think so. He thinks it will result in access problems as a result of "one site-itis". Can you help me ?

The 6th International Sysposium on Home Hemodialysis (with the PD meeting) Feb 27-29,2000 in San Francisco, CA will have a session on "The Art of Dialysis Access Cannulation" and a home hemo patient named Geroge Harper will talk about self cannulation (he has used the buttonhole technique for years) Dr. Twardowski has used the buttonhole for his patients as well as Dr. Peter Lundin for himself for >20 years. Your nephrologist might want to contact Dr. Twardowski. I will get a full reference list for the buttonhole technique and post it for you next week.

web site for the conference is www.muhealth.org look under the index for D, under dialysis is the meeting info.

For more buttonhole info see Patt Peterson's post under the topic of Vascular access without a fistula or catheter.
Thanks for the great info Patt!

Thanks to Patt Peterson for her great list of references:

Twardowski, Z., Constant Site (Buttonhole) Method of Needle Insertion for
Hemodialysis; Dialysis and Transplantation, Vol.24,No. 10,October 1995

Twardowski, Z., Harper, G., The "Buttonhole" Method of Needle Insertion
Takes Center Stage in the Attempt to Revive Daily Home Hemodialysis ;
Contemporary Dialysis and Nephrology, Feb. 1997

Kronung, G., et. al. Plastic Deformation of Cimino Fistula by Repeated
Puncture ; Dialysis and Transplantation, Vol. 13, No. 10, October 1984

Scribner, B.H.; The Overriding Importance of Vascular Access ; Dialysis
and Transplantation, Vol. 13, No. 10, October 1984

Scribner, B.H.; Circulatory Access- Still a Major Concern ; Proceedings of
EDTA 1982, Vol. 19

Twardowski, Z., Kubara, H.; Different Sites vs. Constant Sites of Needle
Insertion into Arteriovenous Fistulas for Treatment by Repeated Dialysis , Dialysis and Transplantation, Vol. 8, No. 10, October 1979

Twardowski, Z. Harper, G. ; Buttonhole Method of Needle Insertion into
Arteriovenous Fistulas ; Presentation Transcripts from 3rd International
Symposium on Daily Home Hemodialysis, Feb. 17, 1997

Elizabeth Lindley, Vascular Access Management Among Research Projects by the EDTNA ; NNI August 1999, page 51-54

Lundin, P. ; The AV Fistula ; http://nephron.com/lundin/lunfistula.html

Ouwendyk, M. , Blood Access for Nocturnal Hemodialysis ; Outline from
Presentation at 5th International Symposium on Home Hemodialysis, March 2,1999

Harper, G. ; The Buttonhole Technique of Fistula Access : A Personal
Experience ; http://www.multi-med.com/homehemo/book/harperarticle2.html

This RenalWeb is terrific. I have learned so much from all of you. I thank you and my patients thank you ! Keep up the good work !

We have been using the buttonhole technique for at least twenty years. Sometimes we have used the same puncture site for many years with no problems. Infections are extremely rare.

Sometimes the site hardens so that you have to change the location and it is possible that these (also relatively rare) problems might have something to do with the fact that we have usually from six to eight nurses sticking the needles and not a "single sticker" (see the above mentioned Patt Peterson's post 08-20-99). Of course we try to pass accurate information on the needle angle and depth of penetration to each other. We can't have a single sticker for every patient because of our work shifts.

I have wondered, which would be better:

1) To have the same person stick the needles as often as possible which means that when she or he is not there somebody else, who maybe hasn't done that for weeks or sometimes even months, does the sticking or
2) To rotate the stickers so that every nurse knows every patient's veins reasonably well.

What do you guys think?

Arnold

Arnold,
Where is your dialysis center located (US? if so which state and city. If not which country and city?)
20 years of using the buttonhole technique- you all are experts!!
Do any of the patients self cannulate? It seems like the patient would be the best choice to elimate the staff isssue.
Personally I found it harder to cannulate an access that I had not used in several weeks.
Glad to hear your success with the buttonhole technique. Do you have any pictures of the buttonhole technique- pictures of the fistula with the buttonholes, cannulation of the buttonhole or close up of the skin of the buttonhole? Would be great to be able to share the images with others that don't understand the buttonhole technique. Pictures could be scanned into PowerPoint or saved as a digital image. Our great Web Master could help me find a way to post images.
Thanks for sharing your expertise Arnold!!
Deborah

Medisystems will be demonstrating the Buttonhole technique with their new Buttonhole needle for AVF at the Dialysis Conference in San Francisco , Feb. 27-29. Stop by and see us !

Hi group,

I miss the discussion board. I am now working in a hospital owned and based dialysis unit without net access. I miss the daily web site surfing, but really love my role in staff education. Here is the old info on buttonhole. Hope it helps.

Debbie Brouwer

Are you going to continue to moderate this board Deborah? Please say yes as we surely need you. You have given such great answers to our questions. You are a true professional!

Dawn,

Thanks for the kind words. I really enjoyed my time as the vascular access board moderator. I will still check the board and make posts as often as I can, but due to my new job I am not the moderator. I am so excited to be back into a hospital based acute and chronic dialysis units. I love staff education and it is fun to go to work everyday! Please feel free to e-mail me at dbrouwer@adelphia.net if you have a question or post that I might be able to help answer. We need to all work together to help improve and advance the care of ESRD patients everywhere.

Deborah Brouwer

I agree with Dawn. We miss you Debbie ! Hope the people at your new job appreciate the expertise you bring to them.

Congratulations on being named the Associate Committee Council Member for the American Society of Diagnostic and Interventional Nephrology. I understand you were elected unanimously ! That's quite an accomplishment !

Good luck to you ! Stay in touch !

[This message has been edited by Patt Peterson (edited 10-16-2000).]

[This message has been edited by Patt Peterson (edited 10-17-2000).]

All interested in Buttonhole Cannualtion Technique ...
There will be a discussion on this topic at the Annual Conference on Dialysis in New Orleans, February 19 to 21, 2001.

See their web site for meeting schedule and information www.muhealth.org/~dialysis

Hi I,m working here in the Middle east and I would like to inquire on how the "Button hole teechnique" is being done? So far I know we need to rotate the differnet sites to avoid bleeding and infecton, is it rue?
Thanks!