Buttonhole Technique Better Than Area Puncture Technique on Hemostasis and Pain Associated with Needle Cannulation
Nuntarat Sukthinthai RN*, Aporn Sittipraneet RN*, Banluesak Tummanittayangkoon RN*, Somkiat Vasuvattakul MD**, Thawee Chanchairujira MD**
Affiliation : * Medical Nursing Division, Department of Nursing, Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Division of Nephrology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : The buttonhole (constant site) arteriovenous fistulae cannulation technique, in which the inserted needle utilizes
exactly the same site and the same angle every dialysis session, offers the advantage of an easier cannulation procedure, less
pain associated with cannulation, and fewer complications when compared with the traditional method.
Objective : To compare buttonhole arteriovenous fistula (AVF) cannulation technique with area puncture method on the effect
of hemostasis after needle withdrawal and pain during needle puncture.
Material and Method: The duration of hemostasis after needle withdrawal and pain during needle puncture of AVF were
prospectively recorded in 21 chronic hemodialysis patients at Siriraj Hospital. The data that were collected while using area
puncture with sharp needle and while using buttonhole with blunt needle were compared by using Paired t-test.
Results : Compared with area puncture method, the duration of hemostasis after needle withdrawal in patients using button-
hole method was significantly shorter in both arterial (4.19 + 1.66 mins vs. 9.12 + 2.36 mins, p < 0.0001) and venous site
(3.92 + 1.37 mins vs. 9.12 + 2.36 mins, p < 0.0001). The pain score during needle puncture of AVF in patients using
buttonhole method was also significantly less than area puncture method in both arterial (1.20 + 0.90 vs. 6.03 + 0.90, p <
0.0001) and venous site (1.38 + 0.75 vs. 5.88 + 0.82, p <0.0001).
Conclusion : Buttonhole AVF puncture method is a useful technique to reduce both the time for hemostasis after needle
withdrawal and pain during needle puncture.
Keywords : Hemodialysis, Constant site, Buttonhole technique, Area puncture, Hemostasis, Pain
