The Beneficial Effects of the Buttonhole Technique Used for the Cannulation of Arteriovenous Fistula Among Hemodialysis Patients: A Literature Review

Arteriovenous fistula (AVF) is a “life-line” for hemodialysis patients. Complications associated with AVF cannulation including the occurrence of vessel stenosis and formation of false aneurysms can substantially shorten the length of AVF survival and its utilization. To minimize the damages to vessel walls of AVF, various needling techniques involving the utilization of sharp or blunt needles, and rotating puncture sites are applied in clinical practice. The buttonhole cannulation (BHC) method appears to be a successful technique to solve the problem of puncturing difficult AVFs. However, it is controversial whether BHC should be extended widely to actual practice to generate further beneficial effects or be restricted in clinical use due to a higher risk of adverse AVF complications. This review reports and elaborates on the methods used to create BHC tunnels, the effects of BHC on patient outcomes compared with other cannulation techniques with regard to both objective and subjective aspects, the advantages and disadvantages of BHC, and the measures for improving BHC. According to the published literature, utilizing BHC for AVF cannulation can effectively prevent the complications associated with AVF, while formulating and implementing the standardized BHC procedure, together with comprehensive staff training and self-management education for patients, can substantially reduce the risk of infection. Future studies with rigorous design need to investigate the long-term effects and strengthen the existing evidence regarding the utilization of BHC.