A randomised comparison of the complications, patient- and nursing experiences between the Buttonhole- and the Rope-ladder/area cannulation techniques in hemodialysis arteriovenous fistulas

For the optimal treatment of haemodialysis patients is essential to acquire and
maintain an adequate vascular access. Preferably patients get an aterioveneus
fistula, which will be cannulated every dialysis session. For cannulation of a
fistula exist three commonly used techniques: the rope-ladder technique, the
area technique and the buttonhole technique. The rope-ladder technique uses the
complete fistula. Every session, the new puncture place is chosen below the
last puncture place, so the puncture places will be equally divided over the
total fistula. In the area technique every consecutive puncture will be placed
arbitrary in a region on the fistula. In practice the rope-ladder as well as
the area technique are used simultaneously with the same patient. An other
option to cannulate a fistula is the buttonhole technique. This technique
cannulates every time on the same spot, in the same angle and depth. After a
few cannulations there will be formed a tunnel of scare tissue from the skin
to the blood vessel. After the dialysis session the tunnel closes with a flap
of the vessel wall and a scrab on the skin.
Different publications suggest that the patients who are dialysing with the
buttonhole cannulationtechnique develop less complications, is more
patient-friendly and is easier for the nurses in comparison to the
rope-ladder/areatechnique. Both techniques are commonly used, but real
scientific evidence is still missing to conclude: one technique is superior to
the other technique. The main objective of this study is to compare the
buttonhole cannulationtechnique with the rope-ladder/area technique. The
primary outcome will be the number of complications.

This study will compare the buttonhole cannulation technique and the
rope-ladder/area technique. Primary the number of complications will be
compared. Secondary the differences between both techniques in patient
experience and cannulation ease for the nurses will be observed.

This will be a randomised cohort study.

To the buttonhole cannulation technique apply the same risks to complications
as the rope-ladder/area technique. These are: chance of vascular occlusion,
haematomia, aneurysm development and infections. Many different publications
suggest that the patients who are dialysing with the buttonhole cannulation
technique develop less complications, is more patient-friendly and is easier
for the nurses in comparison to the rope-ladder/areatechnique. Some minor
publications suggest that the buttonhole cannulation technique is a risk factor
to develop shunt infection. But existing literature about the phenomenon is
scarce; further research will be needed to prove a connection. The
participation in this study won't take extra time of the participant.