The application of blunt needle buttonhole puncture of arteriovenous fistula in maintenance hemodialysis patients / 中国实用护理杂志

Objective:To explore the application of blunt needle buttonhole puncture for arteriovenous fistula in maintenance hemodialysis patients and its effect on complications.Methods:Thirty patients with maintenance hemodialysis using blunt needle buttonhole puncture for arteriovenous fistula in the hemodialysis center of Dalian Central Hospital from September 1, 2017 to September 1,2018 were included as blunt needle group. Thirty patients with common sharp needle rope ladder puncture were matched 1∶1 according to age, gender, primary disease and dialysis age as sharp needle group. They were followed up until August 31, 2019. The incidence of pain, compression hemostasis time, infection and internal fistula occlusion after puncture were compared between the two groups, and the methods and techniques of blunt needle puncture were summarized.Results:In blunt needle group, the puncture pain score was 0 in 3 cases, 1-3 in 25 cases, 4-6 in 2 cases and 7-10 in 0 case. In sharp needle group, the puncture pain score was 0 in 0 case, 1-3 in 10 cases, 4-6 in 20 cases and 7-10 in 0 case. The puncture pain in blunt needle group was significantly lower than that in sharp needle group. The difference between the two groups was statistically significant ( χ2 value was 24.156, P<0.01). The compression hemostasis time was less than 10 min in blunt needle group and more than 10 min in sharp needle group. There were 0 case of internal fistula hemangioma in blunt needle group and 21 cases in sharp needle group. The incidence of internal fistula hemangioma in blunt needle group was significantly lower than that in sharp needle group. There were 2 cases of redness at the puncture needle eye in blunt needle group and 1 case in sharp needle group. During the follow-up period, no other serious complications such as internal fistula occlusion occurred in both groups. Conclusions:Blunt needle buttonhole puncture can effectively reduce the incidence of puncture complications, reduce the degree of puncture pain in patients, shorten the compression time from the machine, the treatment is safe, worthy of clinical promotion.

Clinical Experience with Buttonhole Needling in a Single Hemodialysis Center / 대한내과학회지

BACKGROUND/AIMS: The buttonhole technique, in which needle insertion during cannulation is always into the same site, confers advantages including ease of cannulation, ease of achieving hemostasis, and reduced pain compared with rope-ladder needling. We introduced the buttonhole technique in hemodialysis patients experiencing pain during needling. None of the disadvantages associated with the buttonhole technique, such as infection or access events, were observed, due to the short duration of the study. METHODS: Patients undergoing buttonhole needling were observed prospectively. Data were collected on the following parameters: infectious complications, hospitalizations and access events. We compared buttonhole and rope-ladder needling using baseline data. RESULTS: A total of 48 patients (34 males; mean age = 49.4 +/- 13.8 years) were enrolled. Seven patients were excluded: in three patients, the buttonhole technique failed to form a tract, three others underwent kidney transplantation, and one was lost to follow-up. The remaining 41 patients were followed for 15.7 +/- 4.7 months. Thirteen patients suffered infections, as follows: local infections (n = 5), pneumonia (n = 3), bacteremia (n = 2), cellulitis (n = 1), osteomyelitis (n = 1), and liver abscess (n = 1). There were no significant differences between the rope-ladder and buttonhole needling techniques in rates of infection, hospitalization or vascular access events. CONCLUSIONS: The infection rate and access event frequency associated with buttonhole needling did not differ in relation to that of rope-ladder needling.

Clinical Experience with Buttonhole Needling in a Single Hemodialysis Center / 대한내과학회지

BACKGROUND/AIMS: The buttonhole technique, in which needle insertion during cannulation is always into the same site, confers advantages including ease of cannulation, ease of achieving hemostasis, and reduced pain compared with rope-ladder needling. We introduced the buttonhole technique in hemodialysis patients experiencing pain during needling. None of the disadvantages associated with the buttonhole technique, such as infection or access events, were observed, due to the short duration of the study. METHODS: Patients undergoing buttonhole needling were observed prospectively. Data were collected on the following parameters: infectious complications, hospitalizations and access events. We compared buttonhole and rope-ladder needling using baseline data. RESULTS: A total of 48 patients (34 males; mean age = 49.4 +/- 13.8 years) were enrolled. Seven patients were excluded: in three patients, the buttonhole technique failed to form a tract, three others underwent kidney transplantation, and one was lost to follow-up. The remaining 41 patients were followed for 15.7 +/- 4.7 months. Thirteen patients suffered infections, as follows: local infections (n = 5), pneumonia (n = 3), bacteremia (n = 2), cellulitis (n = 1), osteomyelitis (n = 1), and liver abscess (n = 1). There were no significant differences between the rope-ladder and buttonhole needling techniques in rates of infection, hospitalization or vascular access events. CONCLUSIONS: The infection rate and access event frequency associated with buttonhole needling did not differ in relation to that of rope-ladder needling.

Traumatic Buttonhole Deformity of the Thumb / 대한정형외과학회잡지

Traumatic buttonhole deformity is very rare. In rheumatoid arthritis, synovitis of the metacarpophalangeal joint stretches the dorsal capsule and as a result the extensor pollicis brevis gradually becomes attenuated. Also, the extensor pollicis longus progressively subluxed ulnar and volarward. However, in the cases derived from trauma, combination injuries to the dorsoradial capsule, extensor pollicis insertion and ulnar subluxation of extensor pollicis longus, are essential. Authors experienced the cases of two traumatic buttonhole deformities, and performed operative treatment. In one case, the injured extensor pollicis brevis insertion was detached from the capsule and hood. We advanced and reattached the extensor pollicis brevis to the capsule, after imbricating the capsule and established the normal alignment of the extensor pollicis longus. In the other case, the extensor pollicis brevis insertion was maintained, but the capsule and extensor pollicis longus were severely attenuated. At the 12-month follow-up, the clinical results were satisfactory in both cases.

Buttonhole Technique in Hemodialysis / 대한내과학회지

Recently, dialysis population with arteriovenous fistula may have some problems about the cannulation due to aged, incompetent vessels. Thus alternative needling method, buttonhole technique has been suggested for the complicated cannulation route. In spite of various benefits, this technique is difficult to apply in Korean hemodialysis unit because it requires much time to form the buttonhole track or tunnel. Meanwhile, Choi et al. reported the superiority of buttonhole technique using the polycarbonate peg, Biohole(TM). Here, we review the buttonhole technique in hemodialysis including new buttonhole technique using the Biohole(TM).

Clinical Utility of the Buttonhole Technique Using Biohole(TM) in Hemodialysis Patients / 대한내과학회지

BACKGROUND/AIMS: Buttonhole cannulation has been popular because it provides an easy puncture, is less painful, and requires less time for hemostasis. However, the technique requires a skilled staff and a long time to form the tract. A new buttonhole technique using Biohole(TM), which shortens the time needed for tract formation, has been introduced in Europe, North America, and Japan. METHODS: We prepared a cannulation tract using the buttonhole technique and Biohole(TM) over a two-week period and compared the 12-week outcomes between patients who underwent the rope-ladder versus buttonhole techniques. RESULTS: The 40 patients (27 males) had a mean age of 49.1 +/- 14.2 years. Thirteen and 27 patients were cannulated with the rope-ladder and buttonhole techniques, respectively. Patients who underwent the buttonhole technique had more initial pain than did those who received the rope-ladder technique (p = 0.044). The Biohole(TM) procedure improved puncture pain (5.6 vs. 3.4, p = 0.003) and shortened hemostasis time (1.8 vs. 1.3, p = 0.001). Over a two-week period, patients using Biohole(TM) experienced dislocation (20.8%), bleeding at peg sites (8.6%), and pain during peg change (2.4%). Over the 12 week study period, patients who underwent the buttonhole technique had insignificantly less pain than did those who received the rope-ladder technique (p = 0.088), but the former had less bleeding time than the latter (p = 0.000). One patient who received the buttonhole technique experienced one episode of infection (p = 0.327). CONCLUSIONS: The new buttonhole technique using Biohole(TM) is safe and useful in the short term. A long-term, larger, multicenter study is required to confirm these results.

Treatment of the Buttonhole Deformity of Fingers / 대한정형외과학회잡지

A buttonhole deformity of the finger is characterized by flexion of the pmximal interphalangeal joint and hyperextension of the terminal interphalangeal joint. When the central slip of the extensor tendon and the triangular ligament are ruptured,(or severed) on the base of the middle phalanx, buttonhole deformity will result.This article is based on clinical and follow up studies of 5 patients with buttonholedeformities. Five cases were treated by the modified Littler method and were followed from 4 months to 24 months postoperatively and good results were obtained in all cases.