Buttonhole needling of haemodialysis arteriovenous fistulae results in less complications and interventions compared to the rope-ladder technique

Magda M. van Loon*, Tony Goovaerts, Alfons G. H. Kessels, Frank M van der Sande, Jan H. M. Tordoir

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Methods. A total of 75 prevalent haemodialysis patients with autogenous AVF using the BH technique were compared with 70 patients using the rope-ladder technique. The following parameters were registered: haematoma occurrence, redness, swelling, aneurysm formation, the use of sharp or dull needles, miscannulations, and interventions. Needling pain and fear of puncture were assessed using a verbal rating scale (VRS). The duration of the follow-up was 9 months. Results. Patients in the BH group had more unsuccessful cannulations, compared with the rope-ladder method (P <0.0001), but the frequency of haematoma (P <0.0001) and aneurysm formation (P <0.0001) was less. In addition, intervention such as angioplasty (P <0.0001) was higher in patients using the rope-ladder technique. A negative outcome of the BH technique was the higher incidence of access infections compared to the rope-ladder method. Conclusion. This study showed that the BH method is a valuable technique with few complications like haematoma, aneurysm formation and the need for interventions. However, the infections induced by the BH method should not be underestimated. This underlines the importance of an aseptic and correct technique of the buttonhole procedure.
Original languageEnglish
Pages (from-to)225-230
JournalNephrology Dialysis Transplantation
Issue number1
Publication statusPublished - Jan 2010


  • arteriovenous fistula
  • buttonhole technique
  • cannulation
  • rope-ladder technique
  • vascular access

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