Marticorena Rosa M, Hunter Joyce, Macleod Stephen, Petershofer Elizabeth, Dacouris Niki, Donnelly Sandra, Goldstein Marc B
Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, ON, Canada.
Hemodial Int. 2006 Apr;10(2):193-200. doi: 10.1111/j.1542-4758.2006.00094.x.
We describe the St Michael's Hospital (SMH) modified buttonhole (BH) cannulation technique as a method that offers a solution for fistulae with aneurysmal dilatation due to repetitive cannulation in a restricted area. This is a prospective cohort study of 14 chronic hemodialysis (HD) patients with problematic fistulae (marked aneurysmal formation and thinning of the overlying skin, bleeding during treatment, and prolonged hemostasis post-HD) because of repetitive, localized cannulation. Each patient was followed for 12 months. The protocol was as follows: creation of tunnel tracks by 1 to 3 experienced cannulators per patient, using sharp needles. After the tunnel tracks were established and cannulation was easily achieved with dull needles, additional cannulators were incorporated with the guidance of a mentor. Bleeding from cannulation sites during dialysis ceased within 2 weeks and skin damage resolved within 6 months in all patients. Hemostasis time postdialysis decreased from 24 to 15 min. Cannulation pain scores decreased significantly. Access flows and dynamic venous pressure measurements remained unchanged. No interventions were required to maintain access patency. In 2 cases, the aneurysms became much less evident. Complications included one episode of septic arthritis and one contact dermatitis. A third patient developed acute bacterial endocarditis 9 months following completion of her follow-up. The SMH modified BH cannulation technique can salvage problematic fistulae, prevent further damage, and induce healing of the skin in the areas of repetitive cannulation. This technique can be successfully achieved by multiple cannulators in a busy full-care HD unit.
我们将圣迈克尔医院（SMH）改良纽扣式穿刺技术描述为一种为因在受限区域重复穿刺而出现动脉瘤样扩张的动静脉内瘘提供解决方案的方法。这是一项针对14例慢性血液透析（HD）患者的前瞻性队列研究，这些患者因重复局部穿刺而出现有问题的内瘘（明显的动脉瘤形成和覆盖皮肤变薄、治疗期间出血以及血液透析后止血时间延长）。每位患者随访12个月。方案如下：由每位患者1至3名经验丰富的穿刺者使用锐针创建隧道通路。在隧道通路建立且使用钝针易于穿刺后，在指导者的指导下增加穿刺者。所有患者透析期间穿刺部位的出血在2周内停止，皮肤损伤在6个月内愈合。透析后止血时间从24分钟降至15分钟。穿刺疼痛评分显著降低。通路血流量和动态静脉压测量值保持不变。无需进行干预来维持通路通畅。在2例患者中，动脉瘤变得不那么明显。并发症包括1例化脓性关节炎和1例接触性皮炎。第3例患者在随访结束9个月后发生急性细菌性心内膜炎。SMH改良纽扣式穿刺技术可挽救有问题的内瘘，防止进一步损伤，并促使重复穿刺区域的皮肤愈合。在繁忙的全护理血液透析单元中，多名穿刺者可成功实施该技术。
