A Randomized Trial Comparing Buttonhole with Rope Ladder Needling in Conventional Hemodialysis Patients

Buttonhole needling is reported to be associated with less pain than standard needling. The purpose of this study was to compare patient perceived pain and fistula complications in buttonhole and standard needling. In this study, 140 conventional hemodialysis patients were randomly assigned to butto...

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Bibliographic Details
Published in:Clinical journal of the American Society of Nephrology 2012-10, Vol.7 (10), p.1632-1638
Main Authors: MacRae, Jennifer M, Ahmed, Sofia B, Atkar, Rajneet, Hemmelgarn, Brenda R
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Alberta
Anti-Bacterial Agents - administration & dosage
Arteriovenous Shunt, Surgical - adverse effects
Chi-Square Distribution
Female
Hematoma - etiology
Hemorrhage - etiology
Humans
Male
Middle Aged
Original
Pain - diagnosis
Pain - etiology
Pain Measurement
Punctures - adverse effects
Renal Dialysis - adverse effects
Renal Dialysis - methods
Risk Factors
Staphylococcal Infections - drug therapy
Staphylococcal Infections - microbiology
Staphylococcus aureus - isolation & purification
Time Factors
Treatment Outcome
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Summary:Buttonhole needling is reported to be associated with less pain than standard needling. The purpose of this study was to compare patient perceived pain and fistula complications in buttonhole and standard needling. In this study, 140 conventional hemodialysis patients were randomly assigned to buttonhole or standard needling. The primary outcome was patient perceived pain with needling at 8 weeks. Fistula complications of hematoma, bleeding postdialysis, and infection were tracked. Median pain score at 8 weeks using a visual analog scale from 0 to 10 cm was similar for standard and buttonhole needling (1.2 [0.4-2.4] versus 1.5 [0.5-3.4]; P=0.57). Rate of hematoma formation in standard needling was higher (436 versus 295 of 1000 hemodialysis sessions; P=0.03). Rate of no bleeding postdialysis was 23.6 and 28.3 per 1000 in standard and buttonhole needling, respectively (P=0.40). Rate of localized signs of infection in standard versus buttonhole needling was 22.4 versus 50 per 1000 (P=0.003). There was one episode of Staphylococcal aureus bacteremia during the 8 weeks with buttonhole needling and no episodes with standard needling (P=1.00). Within 12 months of follow-up, another two buttonhole needling episodes developed S. aureus bacteremia, and nine buttonhole needling episodes had needling site abscesses requiring intravenous antibiotics versus zero standard needling episodes (P=0.003). Patients had no difference in pain between buttonhole and standard needling. Although fewer buttonhole needling patients developed a hematoma, there was an increased risk of bacteremia and localized signs of infection. Routine use of buttonhole needling is associated with increased infection risk.
ISSN:1555-9041
1555-905X
DOI:10.2215/CJN.02730312