establishing the buttonhole technique as a puncture alternative for arteriovenous fistulas. experience of a centre over 3 years

Introduction: The buttonhole (BH) puncture technique for arteriovenous fistulas is an alternative to the classical staggered puncture. Purpose: We present 3 years’ results incorporating the BH puncture technique for arteriovenous fistulas in our dialysis unit. Material and methods: Twenty-two patients were started on BH technique, 15 men and 7 women (mean age: 62 years; SD: 12), with time spent on dialysis when starting the BH technique of 34 months (SD: 34, median: 27, range: 3–136). Seven patients received acenocoumarol and 9 antiplatelet agents. The vascular access median time at the beginning of the technique was 27 months (range: 3–252). Results: Between 5 and 8 consecutive dialysis sessions were necessary to achieve a proper tunnel puncture. No patient suffered major complications. The average time on BH technique until December 2015 was 12 months (SD: 10, median: 9, range: 1–45). By the end of the study, 5 patients were performing self-puncture. Haemostasis times post-dialysis were reduced from 18.6 min (SD: 8, prior to the BH technique), to 12.2 min (SD: 3 after BH) (p = 0.0005). Conclusions: The BH technique is an alternative puncture technique for dialysis patients. Self-puncture and reduction in haemostasis time are potential beneficial aspects. A greater diffusion of this technique in the haemodialysis units would allow it to be better applied. A highly motivated nursing staff is key and a necessary condition for its implementation.