Arterio-venous fistula buttonhole cannulation technique: a retrospective analysis of infectious complications

O'Brien, Frank J., Kok, Hong Kuan T., O'Kane, Claire, McWilliams, Johanna, O'Kelly, Patrick, Collins, Paula, Walshe, Joseph, Magee, Colm C., Denton, Mark D. and Conlon, Peter J. 2012, Arterio-venous fistula buttonhole cannulation technique: a retrospective analysis of infectious complications, Clinical kidney journal, vol. 5, no. 6, pp. 526-529, doi: 10.1093/ckj/sfs135.

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Title Arterio-venous fistula buttonhole cannulation technique: a retrospective analysis of infectious complications
Author(s) O'Brien, Frank J.
Kok, Hong Kuan T.ORCID iD for Kok, Hong Kuan T.
O'Kane, Claire
McWilliams, Johanna
O'Kelly, Patrick
Collins, Paula
Walshe, Joseph
Magee, Colm C.
Denton, Mark D.
Conlon, Peter J.
Journal name Clinical kidney journal
Volume number 5
Issue number 6
Start page 526
End page 529
Total pages 4
Publisher Oxford University Press
Place of publication Oxford, Eng.
Publication date 2012-12
ISSN 2048-8505
Summary Background There are two main methods of accessing arterio-venous fistulas (AVFs); the 'buttonhole' and the 'rope-ladder' cannulation technique. Several small studies have hypothesized that the buttonhole technique is associated with increased rates of fistula-associated infection. This study addresses this hypothesis.MethodsA retrospective review of all patients attending a large outpatient haemodialysis clinic was performed. Data were collected on the method of cannulation, infection rates, implicated microorganisms, complications of infection and time on haemodialysis.ResultsA total of 127 patients had received haemodialysis via an AVF: 53 via the rope-ladder technique and 74 via the buttonhole technique. Nine episodes of clinically significant bacteraemia were recorded in the buttonhole group. This equated to a rate of 0.073 bacteraemia events per 1000 AVF days. There were no episodes of bacteraemia in the rope-ladder group. Eight infections were due to methicillin-sensitive Staphylococcus aureus (MSSA); one was due to Staphylococcus epidermidis. Three patients with MSSA bacteraemia subsequently developed infective endocarditis. Five patients who developed bacteraemia events had been undergoing home haemodialysis.ConclusionsThis study highlights the infectious complications associated with buttonhole cannulation techniques. All organisms isolated in our cohort were known skin colonizers. The reason for the increased rates of infection is unclear. Given this high rate of often life-threatening infection, we recommend regular audit of infection rates. We currently do not recommend this technique to our patients receiving haemodialysis. © 2012 The Author.
Language eng
DOI 10.1093/ckj/sfs135
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2012, European Renal Association - European Dialysis and Transplant Association
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