Buttonhole Cannulation Is Not Associated with More AVF Infections in a Low-Care Satellite Dialysis Unit: A Long-Term Longitudinal Study

PLoS One. 2015 Nov 17;10(11):e0142256. doi: 10.1371/journal.pone.0142256. eCollection 2015.


Background: Buttonhole cannulation (BHC) has been associated with a greater risk of arteriovenous fistula (AVF)-related infections and septicemia than the rope ladder cannulation (RLC) in in-center hemodialysis (HD). Such infections have never been studied in satellite HD units.

Study design: Retrospective single center study.

Setting and participant: All patients in our satellite HD unit using a native AVF from 1 January, 1990, to 31 December, 2012.

Study period: Two different kinds of cannulation have been used during the study period: From 1 January, 1990 to 1, January, 1998 RLC was used in the unit (period 1). After 1 January, 1998 onwards, all the patients were switched within 3 months to BHC (period 2).

Outcomes: Three different infectious events were observed during the two periods: local AVF infection, bacteremia, and combined infection. The aim of this study was to evaluate the incidence of AVF-related infections in our low-care HD unit and to determine whether BHC is associated with an increased risk of infection in this population.

Results: 162 patients were analyzed; 68 patients participated to period 1 and 115 to period 2. Sixteen infectious events occurred. Incidences of AVF-related infectious events were 0.05 [95% CI, 0.02-0.16] and 0.13/1000 AVF-days [95% CI, 0.0.8-0.23], for period 1 and 2 (p = 0.44) respectively. Recurrence of AVF-related infection was observed only during period 2. Unadjusted incidence rate ratio (IRR) of all infections was 0.39 (95%CI 0.12-1.37). Two complicated infections occurred during the study period: one in period 1 and one in period 2.

Limitations: Observational retrospective single centre study.

Conclusions: BHC is not associated with an increased infectious incidence in our HD population from a satellite dialysis unit. In the rare patients with AVF-related infection it seems necessary to change cannulation sites as recurrence of infection might be an event more frequent with BHC.

MeSH terms

  • Adult
  • Aged
  • Arteriovenous Shunt, Surgical
  • Catheter-Related Infections / epidemiology*
  • Catheterization
  • Catheters, Indwelling / microbiology
  • Community Health Centers
  • Female
  • Humans
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / therapy*
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Renal Dialysis
  • Retrospective Studies

Grant support

The authors have no support or funding to report.