단일 혈액투석 기관에서 Buttonhole 천자의 경험

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.