Abstract
We report a new simple buttonhole (BH) method based on a combination of Twardowski's method with Toma's method. Our previous BH method can be performed by repeated cannulation with a standard sharp needle at the same site and in the same direction by the same medical staff. Thus, the limitation of this method is that it requires the medical staff to perform needling until the establishment of a fixed route, and it also carries a risk of expansion of the hole. Recently, we developed a new method using a dull needle for repeated cannulation after the primary single needling with sharp needle, and we simultaneously evaluated the usefulness and safety of this new method. We enrolled nine HD outpatients who were clinically stable and underwent dialysis three times a week, excluding those with an unfixed puncture route or has past history of blood access infection. After written informed consent was obtained, eight patients (male/female : 2/6, age : 64.3±8.5 years, primary disease : CGN 5, DM 2, NS 1) were enrolled. Seven patients felt less puncture pain and one patient had a shorter hemostatic time after withdrawal of needle. We used a sharp needle at the first cannulation and then tried to insert dull one into the same hole thereafter. Seven patients (87.5%) could undergo insertion of the dull needle after the initial puncture by a sharp needle, however, one patient could not. In the seven successful patients, there was neither blood access infection nor drop-out due to other complications. Dialysis could be performed using the BH for about three months. We compared the pain of cannulation with a sharp needle before making the BH with insertion by dull needle thirty days after making the BH. The pain on insertion became less in six cases (85.7%), while one patient did not feel any pain. The VAS score decreased from 46.7±22.5 (10～70) to 25±13.9 (0～40). However, there was no significant difference. Hemostatic time shortened from twenty to ten minutes in a patient in whom hemostatic time was observed after withdrawal of needle. We developed a new BH method using a dull needle after primary single puncture with a sharp needle. This method can resolve several issues associated with the conventional BH method ; expansion of BH, cost of BH creation and maintaining the same needling staff for each patient. We conclude that this method is more useful and safer than the conventional method, and recommend spreading the use of this technique among patients receiving dialysis.
