Abstract
Background/Aims: The buttonhole technique, in which needle insertion during cannulation is always into the same site, confers advantages including ease of cannulation, ease of achieving hemostasis, and reduced pain compared with rope-ladder needling. We introduced the buttonhole technique in hemodialysis patients experiencing pain during needling. None of the disadvantages associated with the buttonhole technique, such as infection or access events, were observed, due to the short duration of the study. Methods: Patients undergoing buttonhole needling were observed prospectively. Data were collected on the following parameters: infectious complications, hospitalizations and access events. We compared buttonhole and rope-ladder needling using baseline data. Results: A total of 48 patients (34 males; mean age = $49.4{\pm}13.8$ years) were enrolled. Seven patients were excluded: in three patients, the buttonhole technique failed to form a tract, three others underwent kidney transplantation, and one was lost to follow-up. The remaining 41 patients were followed for $15.7{\pm}4.7$ months. Thirteen patients suffered infections, as follows: local infections (n = 5), pneumonia (n = 3), bacteremia (n = 2), cellulitis (n = 1), osteomyelitis (n = 1), and liver abscess (n = 1). There were no significant differences between the rope-ladder and buttonhole needling techniques in rates of infection, hospitalization or vascular access events. Conclusions: The infection rate and access event frequency associated with buttonhole needling did not differ in relation to that of rope-ladder needling.
목적: Buttonhole 천자는 혈액투석 시에 같은 부위를 천자해 천자가 쉽고, 통증이 적으며, 지혈이 빠른 장점들이 있어 국내에선 최근에 저자들에 의해 소개되었다. 방법: 2011년 7월부터 12월까지 buttonhole을 만들고 2013년 2월까지의 buttonhole 천자를 받았던 환자에게서 감염, 입원 및 동정맥루 사건을 조사하여, 동일 환자의 1년 전 ropeladder법으로 투석한 기간의 자료와 비교 분석하였다. 결과: 총 48명(남자 34명, 나이 $49.4{\pm}13.8$세)이 buttonhole 술기를 시작하였고, 3명은 buttonhole을 만들지 못하였고, 3명은 이식, 1명은 전원으로 buttonhole 술기를 중단하였다. Buttonhole 천자를 지속한 41명의 $15.1{\pm}4.7$개월 추적기간에 13명(29.2%)에서 감염이 발생하였고, 동정맥루 국소감염 5명, 폐렴 3명, 균혈증 2명, 봉와직염 1명, 간농양 1명, 골수염 1명 순이었다. 이들의 rope-ladder 천자 기간과 buttonhole 기간의 감염, 입원, 동정맥루 사건은 유의한 차이가 없었다. 결론: Buttonhole 천자는 rope-ladder천자에 비해 감염, 입원 및 동정맥루 사건의 유의한 차이가 없다.