Cannulation training for AV fistulas: Site Rotation and Buttonhole Techniques
- Facility uses best cannulators and best teaching tools (e.g., videos) to teach AVF cannulation to all appropriate dialysis staff.
- Dialysis staff use specific protocols for initial dialysis treatments with new AVFs and assign the most skilled staff to such patients.
- Facility offers option of self-cannulation to patients who are interested and able.
Prevent fistulae from being destroyed by inexperienced staff. Discuss the basics of needle cannulation with all staff.
Changes for Improvement:
Use Experienced Staff and Teaching Tools to Train All Appropriate Dialysis Staff on AVF Cannulation
Identify the experienced cannulators on your staff; make sure they are available to cannulate all new fistulae and to train inexperienced staff. Identify and make available to your staff appropriate teaching tools.
Use Protocols for Initial Dialysis Treatments with New AVF Patients
Dialysis staff should develop and use a specific protocol for initial dialysis treatments with new AV fistula patients and assign the most skilled staff to such patients.
Teach Self-Cannulation to Patients Who Are Interested and Able
Facilities should offer the option of self-cannulation to patients who are interested and able.
A video series to educate dialysis facility staff on successfully cannulating AV fistulas.
A sample policy and procedure statement on successfully cannulating new arteriovenous fistulae and preventing infiltration.
A sample policy and procedure statement on when and how to use clamps in dialysis settings.
An example procedure statement on successful self-cannulation of vascular access.
A checklist for patients who will be self-cannulating
This technique has been identified as a Best Practice for teaching patients to self-cannulate. Reprint permission has been granted by ANNA’s Nephrology Nursing Journal.
Article by Lynda K. Ball cites evidence-based, best demonstrated practices to utilize in improving individual cannulation techniques. Reprint permission has been granted by ANNA’s Nephrology Nursing Journal.
A tool for determining and developing the cannulation competency of dialysis staff
This is an easy-to-use reference document that describes the maturation process, and guidelines for assessment and monitoring of AV fistulas.
An interactive module designed for training both patients and staff regarding the benefits and care of AV fistulae, how to encourage AV fistulae as a primary access, and how to conduct cannulation training.
WebEx recording from April 12, 2011
Article by Lynda K. Ball and Stuart Mott identifies a new phenomenon involving the Buttonhole Technique, and a strategy for prevention. Reprint permission has been granted by ANNA’s Nephrology Nursing Journal.
Article by Lynda K. Ball, provides an evidence-based overview of complications that are leading to incrased infection rates with the Buttonhole Technique. Reprint permission has been granted by ANNA’s Nephrology Nursing Journal.
This wallet ID card was created by the Northwest Renal Network for patients who travel, are hospitalized, or require access intervention. The Northwest Renal Network also offers additional materials for download available through the link above.
This techique allows for stabilization of an upper arm access to enable successful cannulation using both site rotation and buttonhole technique methods. Reprint permission has been granted by ANNA’s Nephrology Nursing Journal.
This technique has been identified asa Best Practice for cannulating buttonhole sites, as well as any difficult upper arm site. Reprint permission has been granted by ANNA’s Nephrology Nursing Journal.
This technique has been identified as a Best Practice for cannulating buttonhole sites. Reprint permission has been granted by ANNA’s Nephrology Nursing Journal.
This historical paper describes the orgin of the buttonhole method, early results, and the reasons why the method has not gained widespread popularity in U.S. hemodialysis centers.
Article by Lynda Ball, provides an evidence-based educational tool for nephrology nurses to enable them to perform and troubleshoot the buttonhole cannulation technique for accessing an AV fistula. Reprint permission has been granted by ANNA’s Nephrology Nursing Journal.
Reprint permission has been granted by ANNA’s Nephrology Nursing Journal.
A short PowerPoint Presentation that explains the damage that using sharp needles can cause to buttonhole sites after transitioning from teh sharps creation phase to utilizing blunt needles. Handout
A handy one page guide to the Buttonhole Technique.
The Salvage of Aneurysmal Fistulae Utilizing a Modified Buttonhole Cannulation Technique and Multiple Cannulators
The landmark research paper by Marticorena et al. (2006) from St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada, describing the creation of buttonhole sites, published in Hemodialysis International.
This is a comprehensive competency checklist that hsoudl be utilized for any Buttonhole Cannulation program. The checklist can be used in conjunction wiht a provider’s buttonhole cannulation policy and procedure.
This is a comprehensive, up-to-date list of educational and research articles published on the topic of Buttonhole Cannulation.