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KMID : 0882420120820030307
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Korean Journal of Medicine
2012 Volume.82 No. 3 p.307 ~ p.312
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Clinical Utility of the Buttonhole Technique Using BioholeTM in Hemodialysis Patients
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Choi Soo-Jeong
Lee Seol-Hyoung
Cho Eun-Hee
Oh Hye-Ran
Kim Eun-Jung
Park Moo-Yong
Kim Jin-Kuk
Hwang Seung-Duk
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Abstract
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Background/Aims: Buttonhole cannulation has been popular because it provides an easy puncture, is less painful, and requires less time for hemostasis. However, the technique requires a skilled staff and a long time to form the tract. A new buttonhole technique using BioholeTM, which shortens the time needed for tract formation, has been introduced in Europe, North America, and Japan.
Methods: We prepared a cannulation tract using the buttonhole technique and BioholeTM over a two-week period and compared the 12-week outcomes between patients who underwent the rope-ladder versus buttonhole techniques.
Results: The 40 patients (27 males) had a mean age of 49.1 ± 14.2 years. Thirteen and 27 patients were cannulated with the rope-ladder and buttonhole techniques, respectively. Patients who underwent the buttonhole technique had more initial pain than did those who received the rope-ladder technique (p = 0.044). The BioholeTM procedure improved puncture pain (5.6 vs. 3.4, p = 0.003) and shortened hemostasis time (1.8 vs. 1.3, p = 0.001). Over a two-week period, patients using BioholeTM experienced dislocation (20.8%), bleeding at peg sites (8.6%), and pain during peg change (2.4%). Over the 12 week study period, patients who underwent the buttonhole technique had insignificantly less pain than did those who received the rope-ladder technique (p = 0.088), but the former had less bleeding time than the latter (p = 0.000). One patient who received the buttonhole technique experienced one episode of infection (p = 0.327).
Conslusions: The new buttonhole technique using BioholeTM is safe and useful in the short term. A long-term, larger, multicenter study is required to confirm these results.
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KEYWORD
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Buttonhole, Arteriovenous shunt, Renal dialysis
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