O22
INFECTIOUS
COMPLICATION
RATES
IN
PATIENTS
UNDERGOING
BUTTONHOLE CANNULATION OF AV FISTULAE COMPARED TO STANDARD
NEEDLING IN A MAINTENANCE HAEMODIALYSIS COHORT
Garthwaite, E, Williams, N, Hoefield, R, Wright, M
Department of Renal Medicine, Leeds Teaching Hospitals NHS Trust
PROBLEM: There is growing evidence to suggest that buttonhole needling (BN) technique for
arterio-venous fistulae (AVF) cannulation is associated with less complications and vascular
interventions compared to standard rope ladder needling (SN). We have previously reported
lower pain scores, aneurysm size and reduced access interventions in patients receiving BN
compared to SN in our renal units. However, there is growing concern that BN may confer an
increased risk of infection compared to SN. We have modified our standard operating procedure
for BN to exclude patients who we believe are ‘high risk’ for infections and mandate fastidious
attention to skin preparation.
PURPOSE: The aim of this analysis was to describe infection rates in patients having BN or
SN in a large maintenance haemodialysis (HD) cohort, across 7 of the Leeds HD units.
DESIGN: We retrospectively assessed infection rates (bacteraemias) in 473 HD patients with
AVF cannulated via BN (n=259) and SN (n=129); arterio-venous grafts (AVG) (n=12) or
venous dialysis catheters (n=73), over an 8 month period. Access use and cannulation
techniques were in accordance with the up to date standard operating procedures (SOP), audited
3-monthly across the units.
FINDINGS: Rates of bacteraemia were similar in BN versus SN, 0.27 and 0.21 per 1000 HD
sessions respectively (p=0.79). This equates to 0.0032 (BN) and 0.0026 (SN) infections per
patient month. There were no reported infections in those patients receiving HD via an AVG.
Rates of bacteraemia were significantly higher in those using venous dialysis catheters at 0.75
per 1000 HD sessions (P<0.05), equating to 0.06 infections per patient month.
CONCLUSIONS: Overall bacteraemia rates in HD patients with native AVF are low in this
HD cohort. This analysis demonstrates that buttonhole needling was associated with similar
rates of bacteraemia in our HD population in an 8 month period.
RELEVANCE: This analysis suggests that continued use of BN (in accordance with our SOP)
is justified in terms of infection risks in HD patients. Long term prospective follow-up is
required to assess the true infectious complication rates associated with BN in our HD cohort.
In addition to improving our native vascular access rates to the highest ever for our HD
population, BN is pivotal in the development of our shared HD care programme, where patient
safety is a priority.