Quote from traumaRUs
What about button-holes? I know in some of our outpatient units, our patients prefer the button-holes and self-stick.
The buttonhole technique is the
best method for cannulating a fistula, which has been used in Europe for years. However, too few units currently teach or practice it in the U.S.
In a nutshell, with the buttonhole technique you want to cannulate the same arterial and venous site over and over. After creating a "tunnel" with a sharp needle (specially trained RNs teach the patient or staff members how to do this), the patient (or staff member) carefully removes the previous scab and then inserts a special blunt needle in the same track for each dialysis treatment; this prevents infiltrations or other damage to the fistula.
One can only hope that this will become a more commonly used method in the future. It is excellent for home hemodialysis, but can also be used in the clinic setting.
Whether or not the buttonhole technique is used, all patients should be encouraged to cannulate their AVF or AVG themselves; however, few choose to do so. More education by staff could improve these numbers. Patients who self-cannulate are usually happy to do so (and so are the staff: nobody can blame them for any missed stick