The Use of Semi-Dull Needles in Buttonhole Cannulation by K1wSY5Jg

VIEWS: 75 PAGES: 100

									                                                               The Buttonhole Cannulation
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                       technique



                                                                           Tony Goovaerts
                                                                           University Hospital St. Luc
Service
de
Néphrologie
                                                                           Brussels, Belgium
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique
                                                               UCL ST.Luc: Prevalent patients




                                                                            •   In-centre HD: 95 (49.0%)
                                                                            •   Home HD: 45 (23, 5%)
                                                                            •   Self-care satellite HD: 24(12%)
Service
                                                                            •   PD: 30 (15,5%)
de
Néphrologie
                                                               Puncture techniques
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                           Rope ladder
                                                                           Regional
                                                                           Buttonhole




Service
de
Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          Rope ladder puncture
                                                               Reasons for not respecting
                                                                    “Rope ladder”
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               Nurses don’t like to miss sticks
                                                               Patients don’t like missed sticks
                                                               Older dialysis population
                                                               More diabetes patients


Service
de
Néphrologie
                                                                 Regional or area puncture
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               Small puncture area
                                                               with:
                                                                  Thinning of the vessel
                                                                  wall
                                                                  Aneurismal formation
                                                                  Stenosis
                                                                  Oozing
                                                                  Longer bleeding times
                                                                  after needle removal
Service
de
Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          Aneurysm
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          Doppler Ultrasound: Aneurysm
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique
                                                               Doppler Ultrasound: Bloodflow Aneurisma




Service
de
Néphrologie
                                                               Buttonhole puncture sites
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                          Well established
                                                                          buttonhole puncture
                                                                          sites




Service
de
Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               Buttonhole puncture site
                                                               after 53 months in older
                                                               patient




Service
de
Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          Doppler Ultrasound: vessel integrity
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          Doppler Ultrasound: tunnel track
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          Doppler Ultrasound: bloodflow
                                                               History of buttonhole puncture
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               • Dr. Twardowski first reported on
                                                                 buttonhole cannulation
                                                               • Originally used for patients with
                                                                 limited puncture sites
                                                               • Proved to be efficient for other
                                                                 patients with native fistula

Service
de
Néphrologie
                                                               History of buttonhole puncture
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               • Dr. Twardowski
                                                               • Dr. Scribner
                                                               • Dr. Krönung



Service
de
Néphrologie
                                                                  Our ‘Buttonhole’ history
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               • 1997: visit University of Missouri,
                                                                 Columbia
                                                               • Scepticism
                                                               • End 1997: ‘buttonhole’ technique in
                                                                 first Home HD patients
                                                               • Enthusiasm
Service
de
                                                               • No blunt needles available!
Néphrologie
                                                               Comparison of 2 methods of needle
                                                                          insertion
                                                                                      Different sites   Constant sites


                                                               Number of fistulas           22               25
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               Number of dialysis          4060             6180
                                                               Time of setting up         15-25             5-15
                                                               Reinsertion (%)            9.91 %           0.96 %
                                                               Hematoma formation         12.5 %            0.1 %
                                                               Fistula limb failure          3                1
                                                               Fistula failure               1                1
                                                               Infection                     1                3
Service
de
                                                               Patients’ preference          -                +
Néphrologie

                                                               Nurses’ preference            -                +
                                                                 Buttonhole cannulation
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               • Growing opinion that the technique has
                                                                 several advantages compared to the
                                                                 other cannulation techniques
                                                               • Infections!?
                                                               • Easy but completely different
                                                               • Nurses have to be trained to become
                                                                 skilled “buttonholers”using blunt
Service
                                                                 needles!!
de
Néphrologie
                                                                 Advantages of Buttonhole
                                                                        puncture
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               Less hematoma         Perfect for patients
                                                                                     with limited
                                                               Less pain             cannulation sites
                                                               Fewer missed sticks   Perfect for home HD
                                                               Shorter bleeding      or self-care patients
                                                               times                 Staff: reduced risk of
                                                               Less scar formation   accidental needle
                                                                                     sticks

Service
de
Néphrologie
                                                               Bleeding times after dialysis
                                                                  N=14        Arterial   Venous
                                                                    W.A.        1’30’’    1’3’’
                                                                    H.P.          2’        5’
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                    F.N.         13’       12’
                                                                    S.G.          6’        4’
                                                                    S.L.        1’30’’      2’
                                                                    E.B.          2       2’30’’
                                                                    E.A.        2’30’’    2’30’’
                                                                    R.B.         1’30     1’30’’
                                                                    B.R.           -      0’45’’
                                                                    S.A.          8       4’15’’
                                                                     Y.S.       1’45’’    2’15’’
                                                                    D.J.          3’        4
                                                                    C.S.          3’      5’30’’
                                                                    R.M.        3’30’’      2’

                                                                   Mean        3’45 ’’    3’50’’
                                                                 Shortest      1’30’’     0’45’’
                                                                10 patients      3’
Service
de
Néphrologie                                                      8 patients                3’
                                                                Bleeding at puncture sites after HD
                                                                           (86 patients )
                                                               Buttonhole group
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                54.1% < 5 min
                                                                40.5% 5 – 10 min
                                                                5.4% > 10 min
                                                               Control group
                                                                27.9 % < 5 min
                                                                58.1% 5 – 10 min
                                                                14% > 10 min
Service
de
Néphrologie

                                                                                          S. Toma et al.
                                                                Comparison of demographics of the
                                                                        study population
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               Characteristics    Rope-ladder   Buttonhole   P-value
                                                                                  (n=70)        (n=75)
                                                               Gender
                                                                     Female       23 (33%)      31 (41%)     0.28
                                                                     Male         47 (67%)      48 (69%)

                                                               Age
                                                                                  22 (31%)      29 (39%)     0.36
                                                                     < 60 years
                                                                     > 60 years   48 (69%)      46 (61%)




Service
de
Néphrologie
                                                                   Diagnostic tests and interventions with the
                                                               different cannulation techniques during 9 months

                                                                                                  Rope-ladder   Buttonhole
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                                                  (n = 70)      (n = 75)     P -value
                                                                Patients with diagnostics tests   28            15
                                                                Diagnostics tests                 73            24           0.004
                                                                      Duplex                      14            11
                                                                      Fistulogram                 51            10
                                                                      MRA                         8             3
                                                                Patients with interventions       21            6
                                                                Interventions                     41            10           0.001
                                                                      Angioplastie                35            2            0.001
                                                                      Trombectomy                 3             1            0.81
                                                                      Surgical revisions          3             3            0.55
                                                                      AB treatments because of    -             4            0.001
                                                                      access-related infections
Service
de
Néphrologie
                                                               Buttonhole puncture technique
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               Two sequences:
                                                                  First: Creation of the tunnel track or
                                                                   “Break-in” period
                                                                  Second: sliding of dull needle through an
                                                                   established path




Service
de
Néphrologie
                                                                    Select the sites
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               Healthiest sections
                                                               Easy to cannulate
                                                               Distance of preferable 8 cm between
                                                               needle tips




Service
                                                                         preferable 8 cm
de
Néphrologie
                                                                Establishing Tunnel Track
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               • Standard procedure
                                                               • Biohole procedure
                                                               • Catheter



Service
de
Néphrologie
                                                               Buttonhole puncture technique
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                Cannulation:
                                                                 -   Disinfection!
                                                                 -   Exact same spots
                                                                 -   Same insertion angle
                                                                 -   Same depth of penetration
                                                                 -   Ideally single sticker!




Service
de
Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          25 degrees angle!
                                                                      Remove scabs
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               Mandatory :
                                                               - Not going “approximately”
                                                                 into the same spot!!!       25°


                                                               - Disinfection before and
                                                                 after!


Service
de
Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          Removal of scabs
        de
                      Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




        Service

        Néphrologie
R. Morticorena
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                      Removal of scabs
                                                               •   Saline
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               •   Alcohol gel
                                                               •   Emla
                                                               •   Chlorexidine creme
                                                               •   Disinfecting Soap
                                                               •   ……

Service
de
Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                               Establishing Tunnel Track
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               • Standard procedure
                                                               • Biohole procedure
                                                               • Catheter



Service
de
Néphrologie
de
                Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                            stick
                                           skin




              vessel
                                                                            Insertion of plug
                                                               BioHole Buttonhole Device*
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                                                     plug
                                                                       Support unit
                                                                                      Support unit


                                                                plug




Service
de
Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                  Test of BioHole Device (1)
                                                               • 12 new patients with new AV fistula
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               • Team of 8 nurses cannulating randomly
                                                               • Tunnel track creation
                                                                 – 10 patients: 6 sessions
                                                                 – 2 patients: 8 sessions
                                                               • Blunt needles
                                                                 – 7 patients from second dialysis onwards
                                                                 – 5 patients from third, fourth or fifth dialysis
                                                                   onwards

Service
de
Néphrologie
                                                               Test of BioHole Device(2)
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               • 3 X BioHole plug came out of tunnel
                                                                 track
                                                               • 1 X haematoma after insertion of plug
                                                               • 1 x bleeding after removal of plug




Service
de
Néphrologie
                                                               Advantages of the BioHole Device
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                • No single sticker?
                                                                • Faster tunnel track formation
                                                                • Better tunnel track formation




Service
de
Néphrologie
                                                               Drawback of the Biohole Device
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                 Only one length!



Service
de
Néphrologie
                                                               Establishing Tunnel Track
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               • Standard procedure
                                                               • Biohole procedure
                                                               • Catheter



Service
de
Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                          de
                                        Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                          Service

                          Néphrologie



Courtesy R. Marticorena
                          de
                                        Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                          Service

                          Néphrologie



Courtesy R. Marticorena
                          de
                                        Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                          Service

                          Néphrologie



Courtesy R. Marticorena
                                                               Buttonhole puncture technique
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               Two sequences:
                                                                  First: Creation of the tunnel track or “Break-in”
                                                                   period
                                                                  Second: sliding of dull needle through an
                                                                   established path




Service
de
Néphrologie
de
                             Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
              Sharp needle
                                                                                         Needles




              Dull needle
                                                               Sliding of dull needle through an
                                                                       established path
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               • Holding needle by wings
                                                               • “Touch” Cannulation




Service
de
Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          Second disinfection
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          Taping
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          Checking
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          Secure fixation
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          Touch Cannulation
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          Touch Cannulation
                                                                      Overall Problem
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               Frequently intermittent use of sharp
                                                               needles instead of dull needles, which
                                                               may lead to increased infection rate




Service
de
Néphrologie
                                                                 Comparison of cannulation characteristics in
                                                               percentages between both cannulation techniques
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               Cannulation Practice   Rope-ladder (n=70)     Buttonhole (n=75)
                                                                                      6882 dialysis sessions 6847 dialysis sessions

                                                               Type of needle
                                                                  Metal sharp         90 %                   44 %
                                                                  Metal dull          -                      56 %
                                                                  Catheter            10 %




Service
de
Néphrologie
                                                               Strict protocol with primary cannulators
                                                                      Name
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                      Date


                                                                                           Arterial   venous   Signature


                                                                      Nurse




                                                                      1st trial dull




                                                                      2nd trial dull


                                                                      Primary cannulator




                                                                      1st trial dull




                                                                      2nd trial dull
Service
de
Néphrologie
                                                                      sharp
                                                                    Results of intervention
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               • Reduction from 44 % to < 2 % use of
                                                                 sharp needles
                                                               • Dramatically improved infection rate



Service
de
Néphrologie
Prospective observational cross-over study to
test the impact of the use of semi-blunt
needles on the quality of the puncture and
the frequency of sharp needles use.
       Semi-Dull Needle



= Dull Needle but with sharper angle
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                               Prospective observational cross-over
                                                                              study
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               •   03/11/2008-O6/03/2009
                                                               •   51 patients with native AV fistula
                                                               •   Age 71 + 9yr, 60% Males, 36% Diabetics
                                                               •   5672 cannulations



Service
de
Néphrologie
                                                                                Phase 1 a (n=29)            Phase 2 a (n=28)


                                                                          SBN            SBN          BN            BN
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                                        Group: Mo, We, Fr
                                                                 BN
                                                                 All                    Group: Tu, Th, So
                                                               patiens     BN            BN                         SBN
                                                                                                     SBN
                                                                n=51

                                                                                Phase 1 b (n=2O)            Phase 2 b (n=19)



                                                               Month 1   Month 2      Month 3      Month 4        Month 5



Service
de
Néphrologie
                                                               BN

                                                                    100
                                                                    90
                                                                    80
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                    70
                                                                    60                                 First attempt
                                                                    50                                 Second attempt
                                                                                                       ref. nurse
                                                                    40
                                                                                                       Sharp needle
                                                                    30
                                                                    20
                                                                    10
                                                                     0
                                                                          All   1a    2a    1b   2b
Service
de
Néphrologie

                                                                           BN   SBN    BN   BN   SBN
                                                                                  Blunt Needle   Semi-Blunt   P-value
                                                                                                   Needle

                                                                 1 st Attempt       94,3 %         94,2 %     0.9897
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                2 nd Attempt        1,89 %         1,47 %


                                                               Prim. Cannulator     2,19 %         2,62 %
                                                                 Blunt needle



                                                               Prim. Cannulator     1,55 %         1,68 %     0.7141
                                                                 Sharp needle

Service
de
Néphrologie
                                                               Buttonhole Wrong Angle
                                                                              • Needle inserted
                                                                                into the
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                                buttonhole
                                                                                tunnel track-
                                                                                but the angle is
                                                                                not in
                                                                                alignment with
                                                                                the vessel flap
                                                                              • The needle can
                                                                                bounce on the
                                                                                vein and not
                                                                                displace the
                                                                                vessel flap

Service
de
Néphrologie
                                                                              Courtesy D. Brouwer
                                                               Buttonhole Wrong Angle
                                                                             Adjust angle to find the
                                                                              flap
                                                                             Lift up or down on the
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                              needle to readjust the
                                                                              angle (10° until the
                                                                              needle drops into the
                                                                              vessel flap
                                                                             Causes: moving needle
                                                                              from angle used to enter
                                                                              the skin, arm
                                                                              positioning not in
                                                                              routine place, fluid
                                                                              status change with
                                                                              edema or patient body
                                                                              weight gain or loss


Service
de
Néphrologie

                                                                                 Courtesy D. Brouwer
                                                               Implementing a Programme
                                                               •   Small group of nurses
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               •   Small group of patients
                                                               •   Which protocol?
                                                               •   Expand
                                                               •   Be vigilant!!!!!!
                                                               •   Primary/reference nurses/cannulators
                                                               •   Promote self-cannulation
Service
de
Néphrologie
                                                                   Teaching self-cannulation
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               •   Importance of disinfection
                                                               •   Importance of removal of scabs
                                                               •   Signs of infection
                                                               •   Minimal use of sharp needles




Service
de
Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          Touch Cannulation
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                               Create new puncture site if
                                                                       necessary!
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service
de
Néphrologie
                                                                     Some discussion points
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               •   Tourniquet?
                                                               •   Bevel up or down?
                                                               •   Needle size?
                                                               •   Rotation of needle?
                                                               •   Antegrade or retrograde needling?


Service
de
Néphrologie
                                                                    Antegrade or retrograde
                                                                          needling?
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               Antegrade: with the flow




Service
                                                                Retrograde: against the flow
de
Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                                          Antegrade (ven) and Retrograde (art)
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                2
                               cm
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
de
              Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




Service

Néphrologie
                                                               Optimal needle directions
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                 Both needles antegrade

                                                                  - Easier for nurse to puncture
                                                                  - Easier for self-puncturing
Service
de
                                                                  - May be fistula protective
Néphrologie
                                                               Antegrade puncturing: may be
                                                                     fistula protective
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                Increased risk of haematoma formation from
                                                                retrograde filling
Service
de
                                                                Tract closure through flow force by antegrade
Néphrologie
                                                                puncture
            Exit site infection
• HD patients have more
  Staphylococcus Aureus
  on their skin than the
  general population (Ball,
  2006)
Exit site infection:
• Caused by a break in
  technique such as
  improper cleansing of the
  skin or scab removal
• Sites may be inflamed,
  red, draining, painful
                              Courtesy R. Morticorena
                                                               Prevention of infections!
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               Strict protocols
                                                               Soaking of scabs
                                                               Scab removers
                                                               Contact time desinfecting agent
                                                               Use of sharp needles
                                                               Reference nurses..?
                                                               New devices……
Service
de
Néphrologie
                                                               Mupirocine?
                                                                Prevention of infections!
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               I am a physician and a dialysis patient using
                                                                  the buttonhole method without any
                                                                  complications now for nearly 4 years.
                                                               I believe the increased infection rates seen
                                                                  with BH are due NOT to the procedure
                                                                  itself, but due to patient and staff
                                                                  technique! I have now dialyzed in 9 units
                                                                  in 7 States and ALL of these units have
                                                                  infection control issues especially with
                                                                  changing gloves and washing hands!
Service
de
Néphrologie                                                                               Peter Laird, MD
                                                                 BH Contra-indications?!
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               • Thin subcutaneous tissue
                                                               • Valvular heart disease
                                                               • Other prosthetic material (pacemaker)
                                                               • Immune suppression



Service
de
Néphrologie
Other Complications          Day 1


of BH Cannulation
Contact Dermatitis caused
by exposure to cleansing    Day 3
solution (Chlorhexidine):

Progress over 2 weeks
changing the cleansing
solution and applying       Day 14

corticoid cream

                                     R. Morticorena
                                                                       Conclusion (1)
                                                               • Buttonhole is a rapidly growing
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                                 cannulation technique for AVF
                                                                 throughout the world
                                                               • Much better than “Area puncturing”
                                                               • The technique is still evolving
                                                               • Strict protocols are mandatory to avoid
                                                                 complications

Service
de
Néphrologie
                                                                       Conclusion (2)
   Cliniques Universitaires Saint-Luc - Bruxelles - Belgique




                                                               • Several studies are underway
                                                               • The use of sharp needles should be
                                                                 reduced to a minimum
                                                               • Primary cannulators?



Service
de
Néphrologie

								
To top