Outcomes of buttonhole and rope-ladder cannulation techniques in a tropical renal service

Smyth, Wendy, Hartig, Vicki, and Manickam, Valli (2013) Outcomes of buttonhole and rope-ladder cannulation techniques in a tropical renal service. Journal of Renal Care, 39 (3). pp. 157-165.

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Abstract

Background: Buttonhole cannulation was introduced into this Queensland Renal Service in 2005. Contrary to published literature, a local review of cannulation outcomes found no greater likelihood of infections with the buttonhole technique.

Objectives: To compare the outcomes of buttonhole and rope-ladder cannulation techniques.

Design: Prospective cohort.

Participants: Consenting patients attending for haemodialysis via an existing arteriovenous fistula (n = 104).

Measurements: Cannulation sites were assessed at every dialysis session for 12 weeks; fear and pain were scored by participants weekly.

Results: No statistically significant differences in infection, haematoma formation, pain or fear between the techniques. Occurrence of aneurysm was higher (p < 0.05) in the rope-ladder group. More patients in buttonhole group required multiple cannulation attempts (p < 0.05). More of the rope-ladder group failed to attend their scheduled dialysis sessions (p < 0.05).

Conclusions and applications to practice: This study confirms that in this setting there are few negative outcomes of either technique of fistula cannulation. Specifically, buttonhole cannulation appears to be a safe alternative means of fistula access to the gold-standard cannulation technique. The Service is examining strategies to improve attendance.

Item ID: 30223
Item Type: Article (Research - C1)
ISSN: 1755-6686
Keywords: buttonhole, haemodialysis, nursing, research, vascular access
Additional Information:

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.

Date Deposited: 04 Feb 2014 04:59
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1199 Other Medical and Health Sciences > 119999 Medical and Health Sciences not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920199 Clinical Health (Organs, Diseases and Abnormal Conditions) not elsewhere classified @ 100%
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