Observational studyAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2020
Risk of Vascular Access Infection Associated With Buttonhole Cannulation of Fistulas: Data From the National Healthcare Safety Network.
Observational study in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
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The trial behind it
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- A comprehensive review of infection risks and management in hemodialysis access sites.Clinical and experimental nephrology · 2026Pooled it
- Cannulation of the arteriovenous fistula in haemodialysis: a systematic review and narrative synthesis.Journal of nephrology · 2025Pooled it
- Disinfection with chlorhexidine is more effective than ethanol for buttonhole cannulation in arteriovenous fistula: a randomized cross-over trial.BMC nephrology · 2025Trial
- Investigation the implementation of evidence-based protocols for cannulation in Arteriovenous Fistula: a mixed methods study.BMC nephrology · 2026Article
- A Randomized Control Trial of MuST for Vascular Access Cannulation in Hemodialysis Patients: Contributions for a Safe Nursing Intervention.Kidney medicine · 2026Article
- [Multiple Single Cannulation Technique Improves the Outcomes of Arteriovenous Graft in Hemodialysis Patients: A Retrospective Study].Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition · 2024Article
- Cannulation Technique of Vascular Access in Hemodialysis and the Impact on the Arteriovenous Fistula Survival: Systematic Review and Meta-Analysis.Journal of clinical medicine · 2023Review
- High-GradeFederal practitioner : for the health care professionals of the VA, DoD, and PHS · 2023Article
- Risk assessment of failure during transitioning from in-centre to home haemodialysis.BMC nephrology · 2022Article
- A comparison of the buttonhole and rope-ladder AVF cannulation techniques and infection rates within the SCOPE collaborative.Pediatric nephrology (Berlin, Germany) · 2021Article
- Cannulation technique and complications in arteriovenous fistulas: a Swedish Renal Registry-based cohort study.BMC nephrology · 2021Article
- Should Buttonhole Cannulation of Arteriovenous Fistulas Be Used? Moderator Commentary.Kidney360 · 2020Article
- Review
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
Abstract
RATIONALE &
objectiveCompared with conventional (rope-ladder cannulation [RLC]) methods, use of buttonhole cannulation (BHC) to access arteriovenous fistulas (AVFs) may be associated with increased risk for bloodstream infection and other vascular access-related infection. We used national surveillance data to evaluate the infection burden and risk among in-center hemodialysis patients with AVFs using BHC. STUDY
designDescriptive analysis of infections and related events and retrospective observational cohort study using National Healthcare Safety Network (NHSN) surveillance data. SETTING &
participantsUS patients receiving hemodialysis treated in outpatient dialysis centers. PREDICTORS: AVF cannulation methods, dialysis facility characteristics, and infection control practices. OUTCOMES: Access-related bloodstream infection; local access-site infection; intravenous (IV) antimicrobial start. ANALYTIC APPROACH: Description of frequency and rate of infections; adjusted relative risk (aRR) for infection with BHC versus RLC estimated using Poisson regression.
resultsDuring 2013 to 2014, there were 2,466 access-related bloodstream infections, 3,169 local access-site infections, and 13,726 IV antimicrobial starts among patients accessed using BHC. Staphylococcus aureus was the most common pathogen, present in half (52%) of the BHC access-related bloodstream infections. Hospitalization was frequent among BHC access-related bloodstream infections (37%). In 2014, 9% (n=271,980) of all AVF patient-months reported to NHSN were associated with BHC. After adjusting for facility characteristics and practices, BHC was associated with significantly higher risk for access-related bloodstream infection (aRR, 2.6; 95% CI, 2.4-2.8) and local access-site infection (aRR, 1.5; 95% CI, 1.4-1.6) than RLC, but was not associated with increased risk for IV antimicrobial start. LIMITATIONS: Data for facility practices were self-reported and not patient specific.
conclusionsBHC was associated with higher risk for vascular access-related infection than RLC among in-center hemodialysis patients. Decisions regarding the use of BHC in dialysis centers should take into account the higher risk for infection. Studies are needed to evaluate infection control measures that may reduce infections related to BHC.
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