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Effect of buttonhole cannulation with a polycarbonate PEG on in-center hemodialysis fistula outcomes: a randomized controlled trial (with editorial)

Effect of buttonhole cannulation with a polycarbonate PEG on in-center hemodialysis fistula outcomes: a randomized controlled trial (with editorial)
Effect of buttonhole cannulation with a polycarbonate PEG on in-center hemodialysis fistula outcomes: a randomized controlled trial (with editorial)
Background: quality improvement strategies to increase and maintain the numbers of arteriovenous fistulas (AVFs) are a critical drive in enhancing the quality of care of patients receiving treatment with hemodialysis. How the AVF is needled is an important consideration in AVF survival; the ideal cannulation technique has not been established to date.

Study design: prospective randomized single-center trial.

Setting & participants: patients on maintenance hemodialysis therapy (N = 140).

Intervention: a 1-year intervention of buttonhole (constant site) or usual-practice (different site) cannulation.

Outcomes: primary study outcome was AVF survival over 1 year, in which AVF failure was defined as an AVF no longer used for hemodialysis (also referred to as assisted patency). Secondary outcomes included primary patency, number of access interventions, bleeding time, infection rate, cannulation time and pain, and aneurysm formation.

Results: demographic data were similar for both groups. The primary outcome measure of AVF survival at 1 year was statistically significantly increased in the buttonhole group (100% vs 86% with usual practice; P = 0.005, log-rank test). In the buttonhole group, there were fewer interventions (19% vs 39% in usual practice) and less existing aneurysm enlargement (23% vs 67% in usual practice). There were no bacteremia events in the buttonhole group and 2 in the usual-practice group (0.09/1,000 AVF days). There were no significant differences in bleeding times and lignocaine use between the 2 groups.

Limitations: a single-center study, lack of blinding.

Conclusions: in this study, AVF survival was significantly greater when using buttonhole cannulation. The buttonhole technique significantly decreased the need for access interventions and reduced existing aneurysm enlargement. Concerns of increased infection rates or prolonged bleeding times with the buttonhole technique were not seen in this study. The buttonhole technique should be considered the cannulation technique of choice for AVFs
0272-6386
81-88
Vaux, E.
e7154daa-9a8b-4e41-ad07-45c6bf18222c
King, J.
c28e1d73-7f6a-4e59-9354-bbba329f1b01
Lloyd, S.
b815e1a3-bd3a-4f13-b06f-ca661ed79c1f
Moore, J.
d14b0333-92fc-4d44-8c33-6b008956be4a
Bailey, L.
b67d7716-d1ff-4ceb-bcac-4038ff8000ca
Reading, Isabel
6f832276-87b7-4a76-a9ed-b4b3df0a3f66
Naik, R.
47bf4d4f-32d5-4dfc-8cb2-3472928e29a7
Vaux, E.
e7154daa-9a8b-4e41-ad07-45c6bf18222c
King, J.
c28e1d73-7f6a-4e59-9354-bbba329f1b01
Lloyd, S.
b815e1a3-bd3a-4f13-b06f-ca661ed79c1f
Moore, J.
d14b0333-92fc-4d44-8c33-6b008956be4a
Bailey, L.
b67d7716-d1ff-4ceb-bcac-4038ff8000ca
Reading, Isabel
6f832276-87b7-4a76-a9ed-b4b3df0a3f66
Naik, R.
47bf4d4f-32d5-4dfc-8cb2-3472928e29a7

Vaux, E., King, J., Lloyd, S., Moore, J., Bailey, L., Reading, Isabel and Naik, R. (2013) Effect of buttonhole cannulation with a polycarbonate PEG on in-center hemodialysis fistula outcomes: a randomized controlled trial (with editorial). American Journal of Kidney Diseases, 62 (1), 81-88. (doi:10.1053/j.ajkd.2013.01.011). (PMID:23473984)

Record type: Article

Abstract

Background: quality improvement strategies to increase and maintain the numbers of arteriovenous fistulas (AVFs) are a critical drive in enhancing the quality of care of patients receiving treatment with hemodialysis. How the AVF is needled is an important consideration in AVF survival; the ideal cannulation technique has not been established to date.

Study design: prospective randomized single-center trial.

Setting & participants: patients on maintenance hemodialysis therapy (N = 140).

Intervention: a 1-year intervention of buttonhole (constant site) or usual-practice (different site) cannulation.

Outcomes: primary study outcome was AVF survival over 1 year, in which AVF failure was defined as an AVF no longer used for hemodialysis (also referred to as assisted patency). Secondary outcomes included primary patency, number of access interventions, bleeding time, infection rate, cannulation time and pain, and aneurysm formation.

Results: demographic data were similar for both groups. The primary outcome measure of AVF survival at 1 year was statistically significantly increased in the buttonhole group (100% vs 86% with usual practice; P = 0.005, log-rank test). In the buttonhole group, there were fewer interventions (19% vs 39% in usual practice) and less existing aneurysm enlargement (23% vs 67% in usual practice). There were no bacteremia events in the buttonhole group and 2 in the usual-practice group (0.09/1,000 AVF days). There were no significant differences in bleeding times and lignocaine use between the 2 groups.

Limitations: a single-center study, lack of blinding.

Conclusions: in this study, AVF survival was significantly greater when using buttonhole cannulation. The buttonhole technique significantly decreased the need for access interventions and reduced existing aneurysm enlargement. Concerns of increased infection rates or prolonged bleeding times with the buttonhole technique were not seen in this study. The buttonhole technique should be considered the cannulation technique of choice for AVFs

Full text not available from this repository.

More information

Published date: July 2013
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 366035
URI: https://eprints.soton.ac.uk/id/eprint/366035
ISSN: 0272-6386
PURE UUID: 277e6361-2731-4598-901d-b514daf605c4
ORCID for Isabel Reading: ORCID iD orcid.org/0000-0002-1457-6532

Catalogue record

Date deposited: 20 Jun 2014 10:23
Last modified: 19 Jul 2019 21:10

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