Research Findings Question the Use of Buttonhole Cannulation in Routine Clinical Practice

In a CJASN analysis of clinical outcomes in 90 home hemodialysis patients, buttonhole (blunt needle) cannulation of vascular arteriovenous fistulae was associated with higher rates of infectious events, increased staff support requirements, and no reduction in surgical fistula interventions compared with traditional rope ladder (sharp needle) cannulation. Initially, patients were trained in rope ladder; then from 2004, all incident patients were started on buttonhole, and prevalent patients were converted to this cannulation method. The investigators also performed a systematic review of the published literature, finding that buttonhole cannulation is associated with a higher risk of arteriovenous fistula–related infections.