Buttonhole Cannulation

Anna Flynn

Aim of Buttonholes

• Aim is to create one tunnel down to the fistula vessel for each needle

• Scab which forms between each treatment is lifted off and area thoroughly cleaned each time before the next needle goes in

• Can be developed using sharp cannulation needles or using the Biohole® Buttonhole Device

Buttonhole Cannulation

• No different to normal cannulation except…

• Cannulate exactly the same (each session)– Site

– Angle

– Depth of penetration

• Literature suggests at least 6 cannulations with sharp needle – probably more like 9 to 12

Access to the Blood Stream

A flap or trap door is created at the end of the tunnel in the blood vessel and this closes over

when the needle is removed after the treatment The flap is opened again with the next needle

insertionOnce the tunnel is created a new track does not need to be cut for each treatment, this is why a

sharp needle is no longer required

Needles

Sharp needle Blunt needle

Blood flow

Blood flow

Small flap created in vein wall

How Does Buttonholing Work

Blood flow

Blood flow

Remove needle

Flap raises sealing puncture site

How Does Buttonholing Work

Biohole® Buttonhole Device• For creating buttonhole sites – keep track open

between cannulations• Excellent in busy units with multiple cannulators • Sterile polycarbonate peg• Inserted down track created after removal of AVF

needle• Peg dressed & left in place between dialyses• 6-8 pegs required prior to trying dull AVF needles• Expensive

Biohole® Buttonhole Device

Biohole® Buttonhole Pegsin place

Biohole® Buttonhole Pegsin place

Thorough cleaning before removal

Following Biohole Peg Removal

Thanks to Nipro for use of photo

Cannulation with sharp needle

Sharp needle successfully inserted

Inserting the Biohole Buttonhole Peg

Inserting the Biohole Buttonhole Peg

Inserting the Biohole Buttonhole Peg

Biohole® Buttonhole Pegs in place

Pegs covered with waterproof dressing

Pegs covered with waterproof dressing