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

O'Brien FJ, Kok HK, O'Kane C, McWilliams J, O'Kelly P, Collins P, Walshe J, Magee CC, Denton MD, Conlon PJ - Clin Kidney J (2012)

Bottom Line: Nine episodes of clinically significant bacteraemia were recorded in the buttonhole group.This study highlights the infectious complications associated with buttonhole cannulation techniques.All organisms isolated in our cohort were known skin colonizers.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology , Beaumont Hospital , Dublin , Ireland.

ABSTRACT

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.

Methods: A 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.

Results: A 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.

Conclusions: This 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.

No MeSH data available.


Related in: MedlinePlus

Survival curve showing time to AVF infection in both groups P = 0.023.
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SFS135F1: Survival curve showing time to AVF infection in both groups P = 0.023.

Mentions: Patients in the buttonhole group were more likely to be younger, and were more likely to be male. There were no differences in home haemodialysis uptake between the sexes. Patients in the buttonhole group had an average longer dialysis duration per session. There were similar numbers of patients with diabetes mellitus in both the groups. There were nine episodes of AVF infection in the buttonhole group, which equates to 0.073 events per 1000 AVF days. There were no AVF infections in the rope-ladder group. This difference was statistically significant, P = 0.023 (Figure 1).Fig. 1.


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

O'Brien FJ, Kok HK, O'Kane C, McWilliams J, O'Kelly P, Collins P, Walshe J, Magee CC, Denton MD, Conlon PJ - Clin Kidney J (2012)

Survival curve showing time to AVF infection in both groups P = 0.023.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4400558&req=5

SFS135F1: Survival curve showing time to AVF infection in both groups P = 0.023.
Mentions: Patients in the buttonhole group were more likely to be younger, and were more likely to be male. There were no differences in home haemodialysis uptake between the sexes. Patients in the buttonhole group had an average longer dialysis duration per session. There were similar numbers of patients with diabetes mellitus in both the groups. There were nine episodes of AVF infection in the buttonhole group, which equates to 0.073 events per 1000 AVF days. There were no AVF infections in the rope-ladder group. This difference was statistically significant, P = 0.023 (Figure 1).Fig. 1.

Bottom Line: Nine episodes of clinically significant bacteraemia were recorded in the buttonhole group.This study highlights the infectious complications associated with buttonhole cannulation techniques.All organisms isolated in our cohort were known skin colonizers.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephrology , Beaumont Hospital , Dublin , Ireland.

ABSTRACT

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.

Methods: A 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.

Results: A 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.

Conclusions: This 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.

No MeSH data available.


Related in: MedlinePlus