Infection Rates Following Buttonhole Cannulation in Hemodialysis Patients

Arteriovenous fistula (AVF) is the preferred access for hemodialysis (HD). Buttonhole (BH) needling has increased following the introduction of “blunt” fistula needles. Although some reported advantages for BH needling, others have reported increased infection risk. As such we reviewed our center pr...

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Bibliographic Details
Published in:Therapeutic apheresis and dialysis 2016-10, Vol.20 (5), p.476-482
Main Authors: Collier, Sophie, Kandil, Hala, Yewnetu, Enat, Cross, Jennifer, Caplin, Ben, Davenport, Andrew
Format: Article
Language:English
Subjects:
Aged
Arteriovenous fistula
Arteriovenous Shunt, Surgical - methods
Bacteremia
Bacteremia - epidemiology
Bacteremia - mortality
Bacteremia - prevention & control
Buttonhole
Cannulation
Catheter-Related Infections - epidemiology
Catheter-Related Infections - mortality
Catheter-Related Infections - prevention & control
Catheterization - adverse effects
Catheterization - methods
Catheterization, Central Venous - adverse effects
Catheterization, Central Venous - methods
Female
Hemodialysis
Humans
Male
Middle Aged
Renal Dialysis - methods
Retrospective Studies
Staphylococcal Infections - epidemiology
Staphylococcal Infections - mortality
Staphylococcal Infections - prevention & control
Staphylococcus
Staphylococcus aureus - isolation & purification
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Summary:Arteriovenous fistula (AVF) is the preferred access for hemodialysis (HD). Buttonhole (BH) needling has increased following the introduction of “blunt” fistula needles. Although some reported advantages for BH needling, others have reported increased infection risk. As such we reviewed our center practice, and the effect of both nasal screening and eradication and re‐education and training programs. We audited the outcomes of 881 HD patients dialyzed between November 2009 and May 2012, divided into three groups: 175 dialyzing exclusively by central venous catheter (CVC), 478 exclusively by area needling AVF (AVF) and 219 by BH. There were 31 Staphylococcus aureus bacteremias (SABs); 14 (45.2%) dialyzing with CVCs, 12 (38.7%) BH and five (16.1%) AVF. The 30 day mortality rate for SAB was 7.5% with a complication rate of 22.6%. The hazard ratio for first SAB was significantly greater for both CVC and BH access compared to AVF (5.3 (95% CI –1.9–18.6), P 
ISSN:1744-9979
1744-9987
DOI:10.1111/1744-9987.12409