Chow Josephine, Rayment Glenda, San Miguel Susana, Gilbert Margaret
Area Cardiovascular Stream, Sydney South West Area Health Service, Australia.
J Ren Care. 2011 Jun;37(2):85-93. doi: 10.1111/j.1755-6686.2011.00211.x.
This multicentre, prospective, open label, randomised controlled trial was to determine whether buttonhole cannulation technique in new and established haemodialysis fistula reduced complications and prolonged the access life compared to usual practice.
Seventy subjects were recruited for this study. Subjects randomised to the buttonhole group had their fistula cannulated by the same staff member for two to four weeks at the same angle and direction with sharp needles. Once the tunnel was developed, blunt needles were used. The control group continued with usual practice (rope ladder rotation technique).
Infection at the cannulation site occurred in four patients in the buttonhole group and one in the rope ladder rotation group (p = 0.11). Haematomas at the cannulation site and site pain experienced during the dialysis session were more often recorded for the buttonhole group (p < 0.05).
This study showed that buttonhole cannulation resulted more infections, haematoma formation and site pain during dialysis than with the rope ladder rotation group. A further larger scale longitudinal study is recommended.
本多中心、前瞻性、开放标签、随机对照试验旨在确定与常规做法相比，在新建和已建立的血液透析瘘管中采用纽扣式穿刺技术是否能减少并发症并延长通路使用寿命。
本研究招募了70名受试者。随机分配至纽扣式穿刺组的受试者，由同一名工作人员以相同角度和方向，使用锐针为其瘘管进行两至四周的穿刺。一旦形成隧道，便使用钝针。对照组继续采用常规做法（绳梯旋转技术）。
纽扣式穿刺组有4名患者发生穿刺部位感染，绳梯旋转组有1名患者发生穿刺部位感染（p = 0.11）。纽扣式穿刺组在穿刺部位出现血肿以及在透析过程中出现穿刺部位疼痛的情况更为常见（p < 0.05）。
本研究表明，与绳梯旋转组相比，纽扣式穿刺在透析期间导致更多感染、血肿形成和穿刺部位疼痛。建议进一步开展更大规模的纵向研究。
