Establishment of buttonhole technique as a puncture alternative for arteriovenous fístulas. experience of a centre over 3years. / Instauración de la técnica de buttonhole como alternativa de punción para las fístulas arteriovenosas. Experiencia de un centro en 3años.

ABSTRACT

INTRODUCTION: The buttonhole (BH) puncture technique for arteriovenous fistulas is an alternative to the classical staggered puncture. PURPOSE: We present 3years' results incorporating the BH puncture technique for arteriovenous fistulas in our dialysis unit. MATERIAL AND METHODS: Twenty-two patients were started on BH technique, 15 men and 7 women (mean age 62 years; SD 12), with time spent on dialysis when starting the BH technique of 34 months (SD 34, median 27, range 3-136). Seven patients received acenocoumarol and 9 antiplatelet agents. The vascular access median time at the beginning of the technique was 27 months (range 3-252). RESULTS: Between 5 and 8 consecutive dialysis sessions were necessary to achieve a proper tunnel puncture. No patient suffered major complications. The average time on BH technique until December 2015 was 12 months (SD 10, median 9, range 1-45). By the end of the study, 5patients were performing self-puncture. Haemostasis times post-dialysis were reduced from 18.6min (SD 8, prior to the BH technique), to 12.2minutes (SD 3 after BH) (P=.0005). CONCLUSIONS: The BH technique is an alternative puncture technique for dialysis patients. Self-puncture and reduction in hemostasis time are potential beneficial aspects. A greater diffusion of this technique in the hemodialysis units would allow it to be better applied. A highly motivated nursing staff is key and a necessary condition for its implementation.