This paper was also presented at the VAS 8th International Congress, April 25-27 2013, Prague, Czech Republic, http://dx.doi.org/10.5301/JVA.2013.10890

Abstract from oral presentation: Background: Buttonhole cannulation was introduced into a large regional north Queensland, Australia, Renal Service in 2005 as an alternative to the rope-ladder technique of accessing arteriovenous fistulae. Patients comment favourably on the cosmetic appearance and, together with staff, support the buttonhole technique. Contrary to published literature, a retrospective chart audit of cannulation outcomes found no greater likelihood of infections with the buttonhole technique in this renal service. This prospective cohort study compared the outcomes of the buttonhole and rope-ladder cannulation techniques.

Materials and methods: Patients attending the Renal Service's regional, rural and remote units in October 2011 for haemodialysis via an existing functioning arteriovenous fistula consented (n=104). Cannulation sites were assessed at each dialysis session for 12 weeks; fear and pain were scored by the participant on a visual rating scale weekly during the same period.

Results: Only one participant, form the buttonhole group, self cannulated. Almost two-thirds of the participants in each group had diabetes. There were no statistically significant differences in infection, haematoma formation, pain or fear between the techniques. The occurrence of aneurysm was higher (p<0.05) in the rope-ladder group than in the buttonhole group; one patient required surgical intervention. More patients in the buttonhole group required multiple cannulation attempts (p<0.05). The study also revealed that participants failed to attend 4.5% of the scheduled dialysis sessions, with more of the rope-ladder group failing to attend (p<0.05).

Conclusions: This study confirms that in this setting there are few negative outcomes of either technique of fistula cannulation, and that it appears safe to use buttonhole cannulation as an alternative to the gold-standard rope-ladder cannulation technique. The Service has begun to examine strategies to improve attendance.