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Zhang D, Liang J, Yang Y. Features associated with arteriovenous fistula patency. A meta-analysis. Hemodial Int 2025; 29:31-46. [PMID: 39396921 DOI: 10.1111/hdi.13183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 09/18/2024] [Accepted: 09/27/2024] [Indexed: 10/15/2024]
Abstract
INTRODUCTION It is unclear if cannulation-associated variables such as timing of first cannulation, access creation method, cannulation technique, or needle type are associated with the outcomes of arteriovenous fistulas. We conducted a meta-analysis to investigate such potential associations with 1-year primary patency. METHODS Twenty-eight publications with titles that included "arteriovenous fistula," "patency," "cannulation," "metric," "first cannulation," "hemodialysis," "complication," "vascular," "nursing," and "puncture" were retrieved and reviewed. FINDINGS The 1-year primary patency rates ranged from 0.32 to 0.93. Primary patency rates were significantly lower in patients in whom initial cannulation was done less than 1.5 months after fistula creation compared to fistulas first cannulated more than 1.5 months after anastomosis (odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.32-0.52). The effect of cannulation timing on primary patency rate was attenuated when plastic cannulas were used during the first two to three puncture weeks compared to metal needles (OR = 0.62 vs. 0.34; p = 0.032). Fistulas in the upper arm did not have a higher 1-year primary patency compared to those in the forearm (OR = 1.05, 95% CI: 0.93-1.19). Primary patency of upper arm arteriovenous fistulas was higher in reports from the Americas or Europe compared to reports from Asia. Buttonhole cannulation was not associated with higher patency rates at 1 year compared to rope-ladder cannulation (OR = 1.14, 95% CI: 0.75-1.71). DISCUSSION Early cannulation was associated with reduced 1-year arteriovenous fistula patency. This association was reduced when plastic cannulas were used during the initial 2-3 weeks.
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Affiliation(s)
- Dongjuan Zhang
- Hemodialysis Center, 981th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Chengde, Hebei, China
| | - Jing Liang
- Nursing Department, 981th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Chengde, Hebei, China
| | - Yang Yang
- Hemodialysis Center, 981th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Chengde, Hebei, China
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2
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Chen PC, Sun JL, Hsu HC, Lai YH, Liao YC, Chen PY, Chang HC. Comparison of puncture methods in patients with hemodialysis: A randomized controlled trial. Semin Dial 2023; 36:454-461. [PMID: 36726291 DOI: 10.1111/sdi.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/17/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Arteriovenous fistula or arteriovenous graft is essential to long-term survival and quality of life in patients receiving hemodialysis. To date, no research has examined the clinical impacts of different puncture methods. This study compared the rope ladder and area puncture techniques in terms of vascular patency, pain, and quality of life among patients receiving hemodialysis. METHODS A prospective longitudinal study was performed with 6-month follow-up. A total of 98 participants recruited from a hemodialysis center in Taiwan were randomly assigned to receive the rope ladder technique (experimental group) or the area puncture technique (control group). Vascular patency was assessed by examining access flow and percutaneous transluminal angioplasty rate. Pain and quality of life were measured using the Numerical Pain Rating Scale (NPRS) and Kidney Disease Quality of Life Instrument (KDQOL-36™), respectively. All outcome variables were measured repeatedly and analyzed using a generalized estimating equation. RESULTS Overall, quality of life was significantly better for the experimental group than for the control group (β = 47.23, p < 0.001). The percutaneous transluminal angioplasty rate was lower for the experimental group than for the control group (12.0% vs. 18.8%). However, no significant differences were found in access flow and pain level between the two groups over time. CONCLUSION Hemodialysis patients who received the rope ladder puncture technique had a lower percutaneous angioplasty rate and better quality of life than patients who received the area puncture technique, suggesting that the rope ladder technique could be implemented as a routine cannulation method in hemodialysis clinics.
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Affiliation(s)
- Pei-Ching Chen
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
- Dialysis Center, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Jia-Ling Sun
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Hsiu-Chuang Hsu
- Dialysis Center, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Yao-Hui Lai
- Division of Cardiology, Department of Internal Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
- Department of Nursing, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Yu-Chien Liao
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Pei-Ying Chen
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Hui-Chen Chang
- School of Nursing and Midwifery, Western Sydney University, Rydalmere, NSW, Australia
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Peralta R, Sousa L, Cristovão AF. Cannulation Technique of Vascular Access in Hemodialysis and the Impact on the Arteriovenous Fistula Survival: Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5946. [PMID: 37762887 PMCID: PMC10532371 DOI: 10.3390/jcm12185946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Adequate cannulation technique (CT) methods and successful puncture are essential for hemodialysis (HD) and arteriovenous fistula (AVF) maintenance. This systematic review and meta-analysis was designed to identify which CT allows better AVF primary patency and lower rates of complications in HD patients. The search was carried out on the CINAHL, MEDLINE, Cochrane Library, and Joanna Briggs Institute Library databases to identify all randomized controlled trials (RCTs) and observational studies comparing clinical outcomes of buttonhole (BH) versus rope ladder cannulation (RL) from 2010 to 2022. The Risk-of-Bias (Rob 2) tool was used for RCTs and the ROBINS-I was used for non-randomized studies. RevMan 5.4 was used for the meta-analysis. A total of five RCTs, one quasi-randomized controlled trial, and six observational studies were included. When compared with RL cannulation, BH cannulation significantly increased bacteremia (RR, 2.76, 95% CI (1.14, 6.67), p = 0.02) but showed no differences in AVF primary patency (HR, 1.06, 95% CI (0.45, 4.21), p = 0.90). There was no thrombosis reduction (RR, 0.51, 95% CI (0.23, 1.14), p = 0.10) or intervention number reduction (RR, 0.93, 95% CI (0.49, 1.80), p = 0.84) with BH. Outcomes like pain, hematoma, and aneurism could not be merged due to a lack of data, reported as medians, as well as due to different definitions. The quality in general was poor and the heterogeneity among the studies prevented us from merging the outcomes.
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Affiliation(s)
- Ricardo Peralta
- Lisbon School of Nursing, University of Lisbon, 1600-096 Lisbon, Portugal;
- NephroCare Portugal, Fresenius Medical Care Portugal, 1750-233 Lisbon, Portugal
| | - Luís Sousa
- School of Health Atlântica (ESSATLA), 2730-036 Oeiras, Portugal;
- Comprehensive Health Research Centre (CHRC), 7000-811 Evora, Portugal
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Sousa CN, Teles P, Ribeiro OMPL, Sousa R, Lira MN, Delgado E, Oliveira D, Campos L, Fernandes F, Moura SCM, Delgado MF, Sá TG, Teixeira SMP, Souza LH, Ribeiro RCHM, Oliveira GFN, Mendonça AEO, Ozen N. How to choose the appropriate cannulation technique for vascular access in hemodialysis patients. Ther Apher Dial 2023; 27:394-401. [PMID: 36717974 DOI: 10.1111/1744-9987.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Abstract
The cannulation technique is important for the survival of the arteriovenous access. Choosing the appropriate technique is a complex decision. Such choice must be customized to patients, considering their characteristics, the type of arteriovenous access and the experience of the hemodialysis team. We describe seven items that can help nurses to identify the appropriate cannulation technique: type of arteriovenous access; drainage vein; hygienic self-care profile; experience of the nursing staff in the cannulation technique and nurse-to-patient ratio; hemodialysis treatment method; patient's condition; and patient's decision. Such items can help nurses in decision-making on the "ideal" cannulation technique for each patient.
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Affiliation(s)
- Clemente Neves Sousa
- S Francisco Dialysis Unit, Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
| | - Paulo Teles
- School of Economics and LIAAD-INESC Porto LA, Porto University, Porto, Portugal
| | - Olga Maria Pimenta Lopes Ribeiro
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal.,Nursing School of Porto, Porto, Portugal
| | - Rui Sousa
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal
| | | | | | | | | | | | - Sandra Cristina Mendo Moura
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal.,Mogadouro Dialysis Unit-TECSAM; Unidade de Local Saúde Nordeste, Bragança, Portugal
| | - Millena Freire Delgado
- CINTESIS-Center for Health Technology and Services Research Faculty of Medicine, Porto University, Porto, Portugal
| | | | | | - Lara Helk Souza
- Medical School of São José do Rio Preto (FAMERP), São Paulo, Brazil
| | | | | | | | - Nurten Ozen
- Florence Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey
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Wang LP, Tsai LH, Huang HY, Okoli C, Guo SE. Effect of buttonhole cannulation versus rope-ladder cannulation in hemodialysis patients with vascular access: A systematic review and meta-analysis of randomized/clinical controlled trials. Medicine (Baltimore) 2022; 101:e29597. [PMID: 35866782 PMCID: PMC9302278 DOI: 10.1097/md.0000000000029597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Safe and effective arteriovenous fistula (AVF) puncture techniques must be used to reduce harm to hemodialysis patients. The relative benefits of buttonhole (BH) cannulation over those of rope ladder (RL) cannulation for AVF remain unclear and inconsistent. METHODS This systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Literature searches were conducted in June 2020 in multiple scientific databases including Cochrane library, CINAHL, PubMed/ Medline, Airiti Library, National Digital Library of Theses and Dissertations in Taiwan, Google scholar, Embase, and ProQuest. We included all randomized controlled trials (RCTs) and clinical controlled trials (CCTs) that explored the efficacy of BH cannulation in hemodialysis patients. These included reports published in either English or Chinese that enrolled adults aged 18 years or older who underwent hemodialysis using an autogenous AVF. Studies that showed poor design, such as use of a self-control group or no control group, were excluded from analysis. The critical appraisal skills program checklist for RCTs were used to assess the quality of the evidence and RevMan software were used to perform the meta-analysis. RESULTS Fifteen studies (11 RCTs and 4 CCTs) met the inclusion criteria and were used for the meta-analysis. Meta-analysis showed that BH cannulation significantly reduced aneurysm formation (RR = 0.18, 95% confidence interval [CI] [0.1, 0.32]), stenosis (RR = 0.44, 95% CI [0.25, 0.77]), thrombosis formation (RR = 0.4, 95% CI [0.2, 0.8]), and hematoma (RR = 0.63, 95% CI [0.40, 0.99]) and showed no differences in AVR infection (≦6 months, RR = 2.17, 95% CI [0.76, 6.23]; >6 months, RR = 2.7, 95% CI [0.92, 7.92]) compared to RL cannulation. CONCLUSIONS Given the benefits of BH, this meta-analysis found that BH cannulation should be recommended as a routine procedure for hemodialysis but that hospitals and hemodialysis clinics should strengthen staff knowledge and skills of BH cannulation to reduce the risk of AVF infection.
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Affiliation(s)
- Li-Ping Wang
- Department of Nursing, Chi Mei Medical Center, Chiali, Tainan City, Taiwan, R.O.C
| | - Li-Hwa Tsai
- Department of Nursing, Chi Mei Medical Center, Chiali, Tainan City, Taiwan, R.O.C
| | - Hisang-Yun Huang
- Department of Nursing, Chi Mei Medical Center, Chiali, Tainan City, Taiwan, R.O.C
| | - Chizimuzo Okoli
- Behavioral Health Wellness Environments for Living and Learning (BH WELL) & College of Nursing, University of Kentucky College of Nursing, Lexington, KY, USA
| | - Su-Er Guo
- Department of Nursing, and Graduate Institute of Nursing, and Chronic Diseases and Health Promotion Research Center, College of Nursing, Chang Gung University of Science and Technology (CGUST), Chiayi County, Taiwan, R.O.C
- Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi County, Taiwan, R.O.C
- Department of Safety Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City, Taiwan, R.O.C
- *Correspondence: Su-Er Guo, No. 2, Sec. W., Jiapu Rd., Puzi City, Chiayi County 61363, Taiwan, ROC. (e-mail: )
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Yin J, Tian Z, Li P, Li H, Dong Y, Yang X. A time-saving method of creating AVF buttonholes: indwelling trocar technique. J Clin Nurs 2021; 31:3102-3109. [PMID: 34780093 DOI: 10.1111/jocn.16136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/13/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES This study aims to explore the convenience and practicality of the method of establishing buttonholes with indwelling trocars. BACKGROUND Compared with rope-ladder technique, buttonhole cannulation has better applicability for haemodialysis patients, and the method of buttonhole establishment is particularly important. DESIGN Prospective, observational and cohort study. METHODS We conducted a 12-month observational study on 30 patients who used sharp needles to establish buttonholes and 33 patients who used indwelling trocars to establish buttonholes, and compared the differences between the two groups in the buttonhole formation time, patient-reported cannulation pain, buttonhole success rate, AVF-related infection and patency of AVF. The study adhered to STROBE guidelines. RESULTS The buttonhole formation time of the indwelling trocar group is less than that of the sharp needle group (5.48 ± 0.51 vs. 23.23 ± 3.07, p < .01). When the buttonhole was used for the first time, the cannulation pain of the indwelling trocar group was less than that of the sharp needle group (4.94 ± 1.50 vs. 6.03 ± 1.13, p = .002), but there was no significant difference in this result after 1 month (sharp needle group with 4.50 ± 0.94 vs. indwelling trocar group with 4.12 ± 1.19, p = .169). Compared with all the buttonholes in the indwelling trocar group were established successfully, there were 5 unsuccessful buttonholes in the sharp needle group (p = .02). Three cases of unsuccessful buttonhole patients in the sharp needle group developed AVF-related infection, this result did not appear in the indwelling trocar group (p = .102). The difference in arterial pressure and venous pressure between the two groups was not significant (p = .061, p = .222). CONCLUSIONS Our new method can help buttonhole patients get less track formation time, less cannulation pain, and less fistula infection, thereby bringing them a more comfortable dialysis experience. RELEVANCE TO CLINICAL PRACTICE The new method used in this study not only meets the needs of patients to protect AVF, but also provides convenience for clinical work. In addition, this study analyzed the causes of the AVF infection in buttonhole patients, and provided directions for future research.
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Affiliation(s)
- Jinmei Yin
- Blood Purification Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Zhiwu Tian
- Blood Purification Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Peiqiu Li
- Blood Purification Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Huiwen Li
- Blood Purification Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Yi Dong
- Blood Purification Center, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiaoyue Yang
- Nursing Department, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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Bentata Y, Hamdi F, Al Zaarir H, Abualtayef MT, Haddiya I, Benzirar A, El Mahi O. Cutaneous necrosis of the arteriovenous fistula puncture site in chronic hemodialysis: A historical complication or an ever-present threat? A series of 26 cases. Hemodial Int 2020; 25:29-34. [PMID: 33006232 DOI: 10.1111/hdi.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cutaneous necrosis (CN) at the puncture site of the arteriovenous fistula (AVF) in chronic hemodialysis (CHD) is a rare but potentially fatal complication. The objective of our work was to establish the associated complications, vascular prognosis, and patient survival of CHD patients presenting cutaneous necrosis. METHODS This retrospective study (January 2016 to March 2020) was conducted in the Department of Vascular Surgery and the Department of Nephrology at the University Hospital Center Mohammed VI of Oujda, Morocco. Included were all CHD patients admitted for treatment of cutaneous necrosis at the puncture site of a native AVF. RESULTS Data from 26 cases were collected. The mean age was 58.7 ± 16 years, 70.8% were female, and 25% had diabetic nephropathy; 42.3% of the AVFs were radiocephalic and 46.1% were brachiocephalic; 42.2% of patients presented active bleeding, of whom 91% required a blood transfusion; 80.8% of the AVFs were complicated by aneurysms. Fistulography showed stenosis in 42.3% of cases. Urgent surgical intervention was performed on all the patients. Fifty percent of patients required placement of a short-term hemodialysis catheter. Two patients had presented a recurrence. Death occurred in one case following a massive hemorrhagic shock. CONCLUSION Cutaneous necrosis is a relatively common complication and requires early screening and immediate surgical intervention.
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Affiliation(s)
- Yassamine Bentata
- Nephrology Dialysis and Kidney Transplantation Unit, University Hospital Mohammed VI, Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed First, Oujda, Morocco
| | - Fethia Hamdi
- Nephrology Dialysis and Kidney Transplantation Unit, University Hospital Mohammed VI, Oujda, Morocco
| | - Hussam Al Zaarir
- Vascular Surgery Unit, University Hospital Mohammed VI, Oujda, University Mohammed First, Oujda, Morocco
| | - Mohamed Taha Abualtayef
- Vascular Surgery Unit, University Hospital Mohammed VI, Oujda, University Mohammed First, Oujda, Morocco
| | - Intissar Haddiya
- Nephrology Dialysis and Kidney Transplantation Unit, University Hospital Mohammed VI, Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Medical School, University Mohammed First, Oujda, Morocco
| | - Adnane Benzirar
- Vascular Surgery Unit, University Hospital Mohammed VI, Oujda, University Mohammed First, Oujda, Morocco
| | - Omar El Mahi
- Vascular Surgery Unit, University Hospital Mohammed VI, Oujda, University Mohammed First, Oujda, Morocco
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Stegmayr B, Willems C, Groth T, Martins A, Neves NM, Mottaghy K, Remuzzi A, Walpoth B. Arteriovenous access in hemodialysis: A multidisciplinary perspective for future solutions. Int J Artif Organs 2020; 44:3-16. [PMID: 32438852 PMCID: PMC7780365 DOI: 10.1177/0391398820922231] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In hemodialysis, vascular access is a key issue. The preferred access is an arteriovenous fistula on the non-dominant lower arm. If the natural vessels are insufficient for such access, the insertion of a synthetic vascular graft between artery and vein is an option to construct an arteriovenous shunt for punctures. In emergency situations and especially in elderly with narrow and atherosclerotic vessels, a cuffed double-lumen catheter is placed in a larger vein for chronic use. The latter option constitutes a greater risk for infections while arteriovenous fistula and arteriovenous shunt can fail due to stenosis, thrombosis, or infections. This review will recapitulate the vast and interdisciplinary scenario that characterizes hemodialysis vascular access creation and function, since adequate access management must be based on knowledge of the state of the art and on future perspectives. We also discuss recent developments to improve arteriovenous fistula creation and patency, the blood compatibility of arteriovenous shunt, needs to avoid infections, and potential development of tissue engineering applications in hemodialysis vascular access. The ultimate goal is to spread more knowledge in a critical area of medicine that is importantly affecting medical costs of renal replacement therapies and patients’ quality of life.
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Affiliation(s)
- Bernd Stegmayr
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Christian Willems
- Department of Biomedical Materials, Institute of Pharmacy, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Thomas Groth
- Department of Biomedical Materials, Institute of Pharmacy, Martin Luther University of Halle-Wittenberg, Halle, Germany.,Interdisciplinary Center of Material Research, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Albino Martins
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência e Tecnologia, Barco, Portugal
| | - Nuno M Neves
- 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência e Tecnologia, Barco, Portugal
| | - Khosrow Mottaghy
- Department of Physiology, RWTH Aachen University, Aachen, Germany
| | | | - Beat Walpoth
- Department of Cardiovascular Surgery (Emeritus), University of Geneva, Geneva, Switzerland
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MacRae JM. Should Buttonhole Cannulation of Arteriovenous Fistulas Be Used? CON. ACTA ACUST UNITED AC 2020; 1:322-325. [DOI: 10.34067/kid.0000602019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Vachharajani TJ, Wong L, Niyyar VD, Abreo KD, Mokrzycki MH. Buttonhole Cannulation of Arteriovenous Fistulas in the United States. ACTA ACUST UNITED AC 2020; 1:306-313. [DOI: 10.34067/kid.0000052020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The cannulation technique of a hemodialysis vascular access has remained controversial with differing viewpoints. The quality of dialysis, overall patient safety, and individual dialysis experience often dictate the type of cannulation technique used in clinical practice. The three commonly used techniques to access a hemodialysis vascular access are the rope ladder, area, and buttonhole. Although the buttonhole technique has been around since the mid-1970s, the dialysis community remains divided on its suitability for routine use to provide maintenance hemodialysis therapy. The proponents of this technique value the ease of cannulation with less pain and discomfort whereas the opponents highlight the increased risk of infection. The actual clinical evidence from the United States is limited and remains inconclusive. The current review provides an overview of the available experience from the United States, highlighting the correct technique of creating a buttonhole, summarizing the current evidence, and recommending a need for larger randomized controlled studies in both in-center and home hemodialysis populations.
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11
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Glerup R, Svensson M, Jensen JD, Christensen JH. Staphylococcus aureus Bacteremia Risk in Hemodialysis Patients Using the Buttonhole Cannulation Technique: A Prospective Multicenter Study. Kidney Med 2019; 1:263-270. [PMID: 32734206 PMCID: PMC7380414 DOI: 10.1016/j.xkme.2019.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE & OBJECTIVE Arteriovenous fistulas are the preferred access type for hemodialysis. The buttonhole needling technique has become an alternative to stepladder or area puncture. However, an increased risk for infection has been described. The present study examined the risk for infectious complications with different needling techniques. STUDY DESIGN Prospective multicenter observational cohort study with 5 years of follow-up. SETTING & PARTICIPANTS In-center hemodialysis patients from 5 hemodialysis units in Denmark, dialyzed on a native arteriovenous fistula. 286 patients were included; 144 cannulated with the buttonhole technique. EXPOSURE The buttonhole cannulation technique was compared to the stepladder or area puncture technique. OUTCOMES Primary end points: event rates of access-related Staphylococcus aureus bacteremia and the HR for first access-related S aureus bacteremia. Secondary end points: local infections and access-related S aureus bacteremia-related metastatic infections and mortality. ANALYTICAL APPROACH Time-to-event analysis using Cox proportional hazards regression to estimate the HR of access-related S aureus bacteremia in buttonhole cannulation compared to stepladder/area puncture. Poisson regression was used for incidence rate ratio calculations. RESULTS S aureus caused 48 access-related bacteremias; 43 (90%) in the buttonhole group compared with 5 (10%) in the stepladder/area group. The HR for first access-related S aureus bacteremia was significantly higher for buttonhole cannulation compared to stepladder/area needling (unadjusted, 6.8 [95% CI, 2.4-19.1]; adjusted, 8.4 [95% CI, 2.9-24.2]). The incidence rate ratio for access-related S aureus bacteremia was 6.8 (95% CI, 2.9-16.1), and the incidence rate ratio of local cannulation-site infection without access-related S aureus bacteremia was 3.8 (95% CI, 1.3-15.4) for buttonhole cannulation compared to stepladder/area needling. LIMITATIONS Nonrandomized observational design, prevalent hemodialysis patients. CONCLUSIONS Access-related S aureus bacteremia rates were very high for buttonhole cannulation compared to stepladder/area needling, questioning the use of buttonhole cannulation in routine clinical practice. A restrictive approach to buttonhole use is recommended, with buttonhole cannulation only being used as a second alternative to area technique when stepladder cannulation is not feasible.
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Affiliation(s)
- Rie Glerup
- Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark
| | - My Svensson
- Department of Renal Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jens D. Jensen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jeppe H. Christensen
- Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark
- Institute of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Baena L, Merino JL, Bueno B, Martín B, Sánchez V, Caserta L, Espejo B, Domínguez P, Gómez A, Paraíso V. Establishment of buttonhole technique as a puncture alternative for arteriovenous fístulas. experience of a centre over 3years. Nefrologia 2017; 37:199-205. [PMID: 28434704 DOI: 10.1016/j.nefro.2016.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/17/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The buttonhole (BH) puncture technique for arteriovenous fistulas is an alternative to the classical staggered puncture. PURPOSE We present 3years' 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, 5patients were performing self-puncture. Haemostasis times post-dialysis were reduced from 18.6min (SD: 8, prior to the BH technique), to 12.2minutes (SD: 3 after BH) (P=.0005). CONCLUSIONS The BH technique is an alternative puncture technique for dialysis patients. Self-puncture and reduction in hemostasis time are potential beneficial aspects. A greater diffusion of this technique in the hemodialysis units would allow it to be better applied. A highly motivated nursing staff is key and a necessary condition for its implementation.
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Affiliation(s)
- Laura Baena
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - José L Merino
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España.
| | - Blanca Bueno
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - Beatriz Martín
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - Verónica Sánchez
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - Luca Caserta
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - Beatriz Espejo
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - Patricia Domínguez
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - Alicia Gómez
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
| | - Vicente Paraíso
- Sección de Nefrología, Hospital Universitario del Henares. Coslada, Madrid, España
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Labriola L, Jadoul M. Moderator's View: Buttonhole cannulation of arteriovenous fistulae: great caution is warranted: Table 1. Nephrol Dial Transplant 2016; 31:530-3. [DOI: 10.1093/ndt/gfw028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/01/2016] [Indexed: 11/12/2022] Open
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Nadeau-Fredette AC, Johnson DW. Con: Buttonhole cannulation of arteriovenous fistulae. Nephrol Dial Transplant 2016; 31:525-8. [DOI: 10.1093/ndt/gfw030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/22/2015] [Indexed: 11/14/2022] Open
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Lee T, Haq NU. New Developments in Our Understanding of Neointimal Hyperplasia. Adv Chronic Kidney Dis 2015; 22:431-7. [PMID: 26524947 DOI: 10.1053/j.ackd.2015.06.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 06/26/2015] [Indexed: 12/20/2022]
Abstract
The vascular access remains the lifeline for the hemodialysis patient. The most common etiology of vascular access dysfunction is venous stenosis at the vein-artery anastomosis in arteriovenous fistula and at the vein-graft anastomosis in arteriovenous grafts (AVG). This stenotic lesion is typically characterized on histology as aggressive venous neointimal hyperplasia in both arteriovenous fistula and AVG. In recent years, we have advanced our knowledge and understanding of neointimal hyperplasia in vascular access and begun testing several novel therapies. This article will (1) review recent developments in our understanding of the pathophysiology of neointimal hyperplasia development in AVG and fistula failure, (2) discuss atypical factors leading to neointimal hyperplasia development, (3) highlight key novel therapies that have been evaluated in clinical trials, and (4) discuss future opportunities and challenges to improve our understanding of vascular access dysfunction and translate this knowledge into novel and innovative therapies.
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Wong B, Muneer M, Wiebe N, Storie D, Shurraw S, Pannu N, Klarenbach S, Grudzinski A, Nesrallah G, Pauly RP. Buttonhole Versus Rope-Ladder Cannulation of Arteriovenous Fistulas for Hemodialysis: A Systematic Review. Am J Kidney Dis 2014; 64:918-36. [DOI: 10.1053/j.ajkd.2014.06.018] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 06/09/2014] [Indexed: 11/11/2022]
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Shrestha B, Boyes S, Brown P. Innocuous-looking skin scab over an arteriovenous fistula: Case report and literature review. World J Nephrol 2014; 3:118-121. [PMID: 25332904 PMCID: PMC4202489 DOI: 10.5527/wjn.v3.i3.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/28/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
Little is written on the management of an innocuous-looking skin scab over an autogenous arteriovenous fistula (AVF) used for haemodialysis. The seriousness of the underlying pathology can be under-estimated, and this may lead to early loss of the AVF, and major-life-threatening haemorrhage. We describe the management of a 78-year-old patient presenting with an innocuous-looking scab over an AVF and review the pertinent literature on this subject.
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Affiliation(s)
- Louise M. Moist
- Schulich School of Medicine and Dentistry and
- Department of and Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada
| | - Gihad E. Nesrallah
- The Li Ka Shing Knowledge Institute, Keenan Research Centre, St. Michael’s Hospital, Toronto, Ontario, Canada; and
- Department of Nephrology, Humber River Hospital, Toronto, Ontario, Canada
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