Abstract
We developed a new simple buttonhole (BH) method combining Twardowski's method and Toma's method. In this study, we evaluated the usefulness and safety of our method. We enrolled hemodialysis patients who were clinically stable, and receiving outpatient dialysis 3 times per week. Nine patients (male/female : 6/3, age : 62.3±17.1 years, primary disease : DM 5, CGN 4) were enrolled. Written informed consent was obtained from each patient. A simple BH was made by repeated cannulation at the same site and in the same direction as the initial cannulation. To ensure precise repitition of the procedure in each patient, cannulation was performed by the same staff using the same type of needle. We repeated cannulation until the resistance to needling decreased, at which point, we considered the establishment of the matured BH route complete. Thereafter, we used a dull needle for the BH and started HD. One patient needed to be re-routed due to difficulty in cannulation. Therefore, we evaluated a total of 10 procedures. Cannulation was repeated 3.3±0.3, 80% and the total BH was generally completed by 3 repeated cannulations. All patients continue using the BH successfully and there has not been any report of infection or drop out during the period of observation (one to ten months). This simple BH method can improve the limitations of both Twardowski's method (expansion of BH) and Touma's (cost of BH creation), and can also be performed safely. The BH method can lead to the prevention of needle-stick injury and should be promoted for the sake of medical safety.
