Toma Shigeki, Shinzato Takahiro, Fukui Hiroyoshi, Nakai Shigeru, Miwa Masamiki, Takai Ichiro, Maeda Kenji
Toma Clinic, 972 Aza-Kochi, Nishihara-cho, Nakagami-gun, Okinawa Prefecture, Japan.
Nephrol Dial Transplant. 2003 Oct;18(10):2118-21. doi: 10.1093/ndt/gfg321.
Up to now, for a successful buttonhole puncture of the vascular access vessel, the fistula should be punctured by the same experienced medical staff for 2-3 months, using sharp needles, until a fixed puncture route is established.
We developed a timesaving method to create the fixed puncture route for the buttonhole technique. In this method, after the usual haemodialysis (HD), a newly developed thumbtack-shaped polycarbonate peg is thrust toward the access vessel along the same path as the puncture needle that has just been removed. Then, at the beginning of the next HD, the peg is removed and a dull puncture needle is inserted along the track already formed by the peg left in place. These steps are repeated at each HD session for 14 days. Thereafter, the vascular access is achieved at HD sessions by inserting a dull puncture needle through the established puncture route.
This buttonhole puncture approach was used in 37 patients for 3 months. While the polycarbonate peg was in place, patients experienced no restrictions in their normal activities of daily living, except during bathing and showering. As for puncture pain, no patient found the pain of the buttonhole technique to be greater than that of the conventional puncture technique. Moreover, no significant bleeding was noted during HD. With this buttonhole puncture approach, only one patient had enough erythema at the puncture site to suggest possible infection. After HD, the time for bleeding to stop was <10 min in 95% of patients.
This study showed the new timesaving method for creating a buttonhole to be safe and useful.
到目前为止，为了成功进行血管通路的纽扣式穿刺，应由同一位经验丰富的医护人员在2至3个月内使用锐针穿刺内瘘，直到建立固定的穿刺路径。
我们开发了一种省时的方法来创建纽扣式技术的固定穿刺路径。在这种方法中，在常规血液透析（HD）后，将新开发的图钉形聚碳酸酯栓子沿着刚拔出的穿刺针的相同路径推向血管通路。然后，在下一次HD开始时，拔出栓子，并沿着栓子留下的已形成的轨迹插入钝头穿刺针。在每次HD治疗期间重复这些步骤，持续14天。此后，在HD治疗期间通过既定的穿刺路径插入钝头穿刺针来实现血管通路。
这种纽扣式穿刺方法在37例患者中使用了3个月。在聚碳酸酯栓子放置期间，患者在日常生活中没有受到限制，除了洗澡和淋浴时。至于穿刺疼痛，没有患者发现纽扣式技术的疼痛大于传统穿刺技术。此外，HD期间未观察到明显出血。采用这种纽扣式穿刺方法，只有1例患者穿刺部位有足够的红斑提示可能感染。HD后，95%的患者止血时间<10分钟。
本研究表明，这种新的省时的纽扣式创建方法是安全且有用的。
