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단일 혈액투석 기관에서 Buttonhole 천자의 경험

Clinical Experience with Buttonhole Needling in a Single Hemodialysis Center

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초록

Background/Aims: The buttonhole technique, in which needle insertion during cannulation is always into the same site, confersadvantages including ease of cannulation, ease of achieving hemostasis, and reduced pain compared with rope-ladder needling. Weintroduced the buttonhole technique in hemodialysis patients experiencing pain during needling. None of the disadvantagesassociated 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 baselinedata. Results: A total of 48 patients (34 males; mean age = 49.4 ± 13.8 years) were enrolled. Seven patients were excluded: in threepatients, the buttonhole technique failed to form a tract, three others underwent kidney transplantation, and one was lost tofollow-up. The remaining 41 patients were followed for 15.7 ± 4.7 months. Thirteen patients suffered infections, as follows: localinfections (n = 5), pneumonia (n = 3), bacteremia (n = 2), cellulitis (n = 1), osteomyelitis (n = 1), and liver abscess (n = 1). Therewere no significant differences between the rope-ladder and buttonhole needling techniques in rates of infection, hospitalization orvascular access events. Conclusions: The infection rate and access event frequency associated with buttonhole needling did not differ in relation to that ofrope-ladder needling.

Abstract

Background/Aims: The buttonhole technique, in which needle insertion during cannulation is always into the same site, confersadvantages including ease of cannulation, ease of achieving hemostasis, and reduced pain compared with rope-ladder needling. Weintroduced the buttonhole technique in hemodialysis patients experiencing pain during needling. None of the disadvantagesassociated 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 baselinedata. Results: A total of 48 patients (34 males; mean age = 49.4 ± 13.8 years) were enrolled. Seven patients were excluded: in threepatients, the buttonhole technique failed to form a tract, three others underwent kidney transplantation, and one was lost tofollow-up. The remaining 41 patients were followed for 15.7 ± 4.7 months. Thirteen patients suffered infections, as follows: localinfections (n = 5), pneumonia (n = 3), bacteremia (n = 2), cellulitis (n = 1), osteomyelitis (n = 1), and liver abscess (n = 1). Therewere no significant differences between the rope-ladder and buttonhole needling techniques in rates of infection, hospitalization orvascular access events. Conclusions: The infection rate and access event frequency associated with buttonhole needling did not differ in relation to that ofrope-ladder needling.

참고문헌 (18)

  1. Hartig V, "“Everyone should buttonhole”: a novel technique for a regional Australian renal service", J Ren Care, 35, pp.114~119 (2009)
  2. 최수정, "혈액투석 환자에게서 BioholeTM 쐐기를 이용한 Buttonhole 천자법의 임상적 유용성", 대한내과학회지, 82(3), pp.307~312 (2012), 대한내과학회
  3. Kim MK, "Clinical effects of buttonhole cannulation method on hemodialysis patients", Hemodial Int, 17, pp.294~299 (2013)
  4. Verhallen AM, "Cannulating in haemodialysis: rope-ladder or buttonhole technique", Nephrol Dial Transplant, 22, pp.2601~2604 (2007)
  5. Marticorena RM, "The salvage of aneurysmal fistulae utilizing a modified buttonhole cannulation technique and multiple cannulators", Hemodial Int, 10, pp.193~200 (2006)
  6. Chow J, "A randomised controlled trial of buttonhole cannulation for the prevention of fistula access complications", J Ren Care, 37, pp.85~93 (2011)
  7. Twardowski Z, "Different sites versus constant sites of needle insertion into arteriovenous fistulas for treatment by repeated dialysis", Dial Trasnplant, 8, pp.978~980 (1979)
  8. Hayashi R, "Vascular access for hemodialysis", Nat Clin Pract Nephrol, 2, pp.504~513 (2006)
  9. Tordoir J, "EBPG on Vascular Access", Nephrol Dial Transplant, 22(2), pp.ii88~117 (2007)
  10. Ohira S, "Japanese Society for Dialysis Therapy guidelines for vascular access construction and repair for chronic hemodialysis", Ther Apher Dial, 10, pp.449~462 (2006)
  11. Murcutt G, "Buttonhole cannulation: should this become the default technique for dialysis patients with native fistulas? Summary of the EDTNA", ERCA Journal Club discussion Autumn 2007, 2008, pp.34, 101~108
  12. Vaux E, "Effect of buttonhole cannulation with a polycarbonate PEG on in-center hemodialysis fistula outcomes: a randomized controlled trial", Am J Kidney Dis, 62, pp.81~88 (2013)
  13. Macrae JM, "Alberta Kidney Disease Network. Arteriovenous fistula survival and needling technique: long-term results from a randomized buttonhole trial", Am J Kidney Dis, 63, pp.636~642 (2014)
  14. Doss S, "Buttonhole cannulation--an unexpected outcome", Nephrol Nurs J, 35, pp.417~419 (2008)
  15. van Loon MM, "Buttonhole needling of haemodialysis arteriovenous fistulae results in less complications and interventions compared to the rope-ladder technique", Nephrol Dial Transplant, 25, pp.225~230 (2010)
  16. Birchenough E, "Buttonhole cannulation in adult patients on hemodialysis: an increased risk of infection", Nephrol Nurs J, 37, pp.491~498 (2010)
  17. Labriola L, "Infectious complications following conversion to buttonhole cannulation of native arteriovenous fistulas: a quality improvement report", Am J Kidney Dis, 57, pp.442~448 (2011)
  18. Van Eps CL, "The impact of extended- hours home hemodialysis and buttonhole cannulation technique on hospitalization rates for septic events related to dialysis access", Hemodial Int, 14, pp.451~463 (2010)

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