A Timesaving Method to Create a Fixed Puncture Route for the Buttonhole Technique

Background: Up to now, for a successful buttonhole puncture of the vascular access vessel, the fistula should be punctured by the same experienced medical staff for 2-3 months, using sharp needles, until a fixed puncture route is established.

Methods: We developed a timesaving method to create the fixed puncture route for the buttonhole technique. In this method, after the usual haemodialysis (HD), a newly developed thumbtack-shaped polycarbonate peg is thrust toward the access vessel along the same path as the puncture needle that has just been removed. Then, at the beginning of the next HD, the peg is removed and a dull puncture needle is inserted along the track already formed by the peg left in place. These steps are repeated at each HD session for 14 days. Thereafter, the vascular access is achieved at HD sessions by inserting a dull puncture needle through the established puncture route.

Results: This buttonhole puncture approach was used in 37 patients for 3 months. While the polycarbonate peg was in place, patients experienced no restrictions in their normal activities of daily living, except during bathing and showering. As for puncture pain, no patient found the pain of the buttonhole technique to be greater than that of the conventional puncture technique. Moreover, no significant bleeding was noted during HD. With this buttonhole puncture approach, only one patient had enough erythema at the puncture site to suggest possible infection. After HD, the time for bleeding to stop was <10 min in 95% of patients.

Conclusion: This study showed the new timesaving method for creating a buttonhole to be safe and useful.