For many years the accepted method of cannulating an AV fistulas for hemodialysis has been the “site rotation or rope ladder” technique. Rotating needle sites was thought to prolong the life of the fistula and minimize aneurism formation.
In the last few years the “buttonhole or single site” cannulation technique has gained popularity. Once healed the buttonhole is similar to the tunnel created in a pierced ear. Less pain with needle insertion, ease of use to promote self cannulation for home dialysis, and use in patients with short fistula lengths are the intended benefits of this technique.
As use of the buttonhole method spreads, the benefits and risks are becoming all too apparent. Historically, AV fistulas were known to have very, very low incidence of infection and as more facilities adopt the buttonhole technique, fistula infections and serious septic infections related to AV fistulas are on the rise.
Okay, here’s the deal, I don’t know which technique is better! There are proponents on both sides of the isle with very strong opinions about this subject. All I do know is that having dealt with several septic infections caused by infected buttonholed fistulas is, I think we need to rethink this method. Perhaps new and improved is not always better. So . . . buyer beware!