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Korean J Med > Volume 87(5); 2014 > Article
The Korean Journal of Medicine 2014;87(5): 574-578.
단일 혈액투석 기관에서 Buttonhole 천자의 경험
최수정1, 조은희2, 이설형2, 오혜란2, 김종혜2, 박무용1, 김진국1, 황승덕1
1순천향대학교 의과대학 내과학교실
2순천향대학교 부천병원 인공신장실
Clinical Experience with Buttonhole Needling in a Single Hemodialysis Center
Soo Jeong Choi1, Eun Hee Cho2, Sul Hyung Lee2, Hye Ran Oh2, Jong Hye Kim2, Moo Yong Park1, Jin Kuk Kim1, Seung Duk Hwang1
1Division of Nephrology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
2Artificial Kidney Unit, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
Corresponding Author: Seung Duk Hwang ,Tel: +82-32-621-5166, Fax: +82-32-621-5018, Email: sd7hwang@schmc.ac.kr
Received: December 31, 2013;   Revised: March 3, 2014;   Accepted: April 30, 2014.
This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial License (http://creativecommons.org/licenses/bync/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background/Aims:
The buttonhole technique, in which needle insertion during cannulation is always into the same site, confers advantages including ease of cannulation, ease of achieving hemostasis, and reduced pain compared with rope-ladder needling. We introduced the buttonhole technique in hemodialysis patients experiencing pain during needling. None of the disadvantages associated 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 baseline data.

Results:
A total of 48 patients (34 males; mean age = 49.4 ± 13.8 years) were enrolled. Seven patients were excluded: in three patients, the buttonhole technique failed to form a tract, three others underwent kidney transplantation, and one was lost to follow-up. The remaining 41 patients were followed for 15.7 ± 4.7 months. Thirteen patients suffered infections, as follows: local infections (n = 5), pneumonia (n = 3), bacteremia (n = 2), cellulitis (n = 1), osteomyelitis (n = 1), and liver abscess (n = 1). There were no significant differences between the rope-ladder and buttonhole needling techniques in rates of infection, hospitalization or vascular access events.

Conclusions:
The infection rate and access event frequency associated with buttonhole needling did not differ in relation to that of rope-ladder needling.
Keywords: Buttonhole cannulation; Arteriovenous fistula; Hemodialysis
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