Twardowski Zbylut J
Division of Nephrology, Department of Medicine, University of Missouri, Columbia, MO - USA.
J Vasc Access. 2015;16 Suppl 9:S54-60. doi: 10.5301/jva.5000349. Epub 2015 Mar 8.
There are two methods of fistula cannulation for hemodialysis. The first, different site or rope-ladder cannulation method, established by originators of the arteriovenous fistula as a blood access for hemodialysis in 1966, relies on changing the puncture sites for each dialysis. The second, constant site or buttonhole method, developed several years later, recommends using the same puncture sites for consecutive dialyses. The first method is prevailing at present, but the second method is becoming more and more popular. The major advantage of this buttonhole method is lower cannulation pain, fewer fistula complications, with the exception of fistula infection, which is more common in some studies. This method is more difficult and requires experienced single cannulator to establish good puncture sites. Home hemodialysis patients using single cannulator, the patient or helper, have better results with this method. Busy dialysis centers with high rotation of cannulators do not have as good results and prefer the rope-ladder method.
血液透析的内瘘穿刺有两种方法。第一种是不同部位或绳梯式穿刺法，由动静脉内瘘的发明者于1966年确立，作为血液透析的血管通路，每次透析都要更换穿刺部位。第二种是固定部位或纽扣式穿刺法，几年后发展而来，建议连续透析时使用相同的穿刺部位。目前第一种方法占主导地位，但第二种方法越来越受欢迎。这种纽扣式穿刺法的主要优点是穿刺疼痛较轻，内瘘并发症较少，但在一些研究中，内瘘感染除外，内瘘感染在这种方法中更为常见。这种方法更难，需要经验丰富的单一穿刺者来建立良好的穿刺部位。对于使用单一穿刺者（患者或助手）进行家庭血液透析的患者，采用这种方法效果更好。插管人员轮换频繁的繁忙透析中心使用这种方法效果不佳，更倾向于绳梯式穿刺法。
