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Buttonhole Cannulation Infection Risk — ESENeph MCQ

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ModerateHaemodialysisButtonhole Cannulation Infection RiskESENeph

A 50-year-old man on haemodialysis has been using a buttonhole cannulation technique for his AV fistula. He develops Staphylococcus aureus bacteraemia from the fistula. What is the known risk with buttonhole technique?

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Correct answer: B — Buttonhole cannulation is associated with a higher risk of S. aureus bacteraemia and local access infection compared to rope-ladder (rotating sites) technique

The buttonhole technique (repeated cannulation through the same tract using blunt needles) was initially thought to reduce pain and aneurysm formation. However, multiple studies and meta-analyses have shown a significantly increased risk of S. aureus bacteraemia and access-related infections compared to the rope-ladder (rotating sites) technique. The tunnel track may become colonised with bacteria. UKKA and KDOQI guidelines now recommend caution with buttonhole technique and emphasise strict aseptic technique if used. Rope-ladder is generally preferred.

Reference: UKKA 2019 – Vascular Access; Muir et al 2014 – Buttonhole vs Rope Ladder Meta-analysis