Presentasi Buttonhole Vs Conventional PDF

Copyright Renal Society of Australasia 2006. Reproduction without author permission prohibited.
Presented by Patty Tsang C N S

Dame Eadith Walker Home
Training Unit
Sydney South West Area Health (Eastern Zone)
D E W Home Training Team
Button Hole Cannulation Method :

1. Disinfect the button hole and surrounding area
2. Remove the scab on the button hole with 18 G
drawing needle
scab
Skin
Blood
vessels
Button Hole Cannulation Method cont.:

3. Disinfect the button hole (again)
4. Insert the cannula in the same puncture site
(button hole) and same angle
Skin
Blood
vessels
Comparison of Blunt v.s. Normal cannula

. Use blunt needle when the track is formed
. Tip & edges of the cannula are less sharp Blunt edges
Blunt needle tip
Normal
Blunt
Puncture Site
Correct Button Hole puncture
Incorrect puncture
Dull (Blunt) B. H. AVF cannula

Benefits :
9
Specially designed for button hole insertion
Less damage at the button hole
Minimize the chance of damaging of blood vessel
Example 1: Traditional Cannulation

Puncturing
different sites
Example 1: continued
Example 2: Traditional Cannulation
Example 3 : Traditional Cannulation

Mr S S AVF 3 y
Cannulated different sites

cannulated different sites for 7 y
Button Hole Technique
Most of AVF can only cannulate at very

limited areas
Example 1: Button Hole Technique

The 1st patient use B H technique in 2004
B H technique for 2.5 y
Mrs K
MRS K (limited cannulation sites)
Example 2: Button Hole Technique
Mrs Y
Example 3: Failed Traditional Method

Changed to B H Technique
2 weeks after MISSED cannulation

-resulted in large haematoma
Example 3: Continued B H Technique

Managed self cannulate within 3 wk
Example 3: Continued
Shows limited area available

for cannulation
Example 3: Continued
Shows that different sites are more

easily cannulated by a nurse - even
then options are limited
Example 4 : Continued
Button hole 18 months
MS N S
Example 5 : Button Hole technique for 2 y
Gortex graft 3 y, Cannulated different sites for 2 y

From the 3rd year cannulated the Gortex for the arterial
Upper arm native AVF for the venous (use B H technique)
Mr L Z
Button hole v.s. cannulate different sites
B/H v.s. Puncture different sites
Ms N
B H technique 18 m
B/H Cannulation Offer :
Less haematoma
Less anxious during cannulation
Less missed cannulation
Less pain do not require L/A reduce cost
less scar formation
Reduce decannulation bleeding time
Shorter training time
B/H is Perfect for pts. with limited access sites for
cannulation
Nocturnal Pt. no chance to Blow Fistula (Dull
needle)
Button Hole Puncture Technique
The Button hole technique is currently supported

by all our Nephrologists at the Sydney South
West Area Health (Eastern Zone).
Since beginning of 2004, we have

increased to fifty patients using
button hole puncture technique
Special Acknowledgements :
To Rhonda Pocknee (NIPRO Product Manager

Sutherland Medical)
To the nursing staff of Dame Eadith Walker

Dialysis Centre : K Grimley, L Haberecht, J
Lelek, J Moustakis, Y Park, F Siu, C Stevens, W
W Tsang, M Zuhair
To Doctor C George
To Rosie Simmonds (Barwon Health)
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Copyright Renal Society of Australasia 2006. Reproduction without author permission prohibited.

Presented by Patty Tsang C N S

D E W Home Training Team

Button Hole Cannulation Method :

Button Hole Cannulation Method cont.:

Comparison of Blunt v.s. Normal cannula

Dull (Blunt) B. H. AVF cannula

Specially designed for button hole insertion

Less damage at the button hole

Minimize the chance of damaging of blood vessel

Example 1: Traditional Cannulation

Example 2: Traditional Cannulation

Example 3 : Traditional Cannulation

Example 4 : Traditional Cannulation

Example 5 : Traditional Cannulation

Example 6 : Traditional Cannulation

Button Hole Technique

Most of AVF can only cannulate at very

Example 1: Button Hole Technique

Example 2: Button Hole Technique

Example 3: Failed Traditional Method

2 weeks after MISSED cannulation

Example 3: Continued B H Technique

Shows limited area available

Shows that different sites are more

Example 5 : Button Hole technique for 2 y

Gortex graft 3 y, Cannulated different sites for 2 y

Button hole v.s. cannulate different sites

B/H v.s. Puncture different sites

B/H Cannulation Offer :

Button Hole Puncture Technique

The Button hole technique is currently supported

Since beginning of 2004, we have

To Rhonda Pocknee (NIPRO Product Manager

To the nursing staff of Dame Eadith Walker

To Rosie Simmonds (Barwon Health)

Question & Discussion

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