Has anyone come across any research to support a particular method of cannulating grafts i.e. with the cutting edge of the needle facing up or down?

Information about alternate cannulation techniques is lacking in the published data that I have been able to find. Medisystems mentions bevel down in their "Cannulation" video. I contacted them and they gave me some references to contact. These are clinicians who currently perform bevel down cannulation on grafts. They are in favor of it. They feel it is less traumatic to the graft. They also find bleeding times to be shorter post treatment.

Another method I am most curious about is the "Buttonhole" technique. I saw a presentation on this at the PD Conference this past February. It is only used on AV fistulas in the US but a gentleman from Sweden got up and said they have been using this technique for 30 years on both AV fistulas and grafts. Anybody out there using this buttonhole technique ? If so, I am very interested in hearing from you.

I attended a conference about 6 years ago that was hosted by a pharmaceutical company that produce the grafts. Studies have shown that bevel down technique without flipping is recommended. I have used this technique for about 6 years and have found success, less bleeding, when you cannulate bevel down, you cause a downward flap and they have found less injury to the graft, whereby it will last longer..

My unit is now being taught with bevel down, and they like it. It takes getting used to, but it works...