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Background: Access to an adequate blood flow is a requirement for successful hemodialysis (HD). !is often means repeated

cannulation of an arteriovenous fistula (AVF), which can lead to damage that needs repair and revision. !e Buttonhole (BH)

method offers a successful cannulation with minimal damage.

Design: A prospective cohort research study was initiated in two HD units in St. John’s, Newfoundland and Labrador, to assess the

effects of cannulating AVFs using the BH technique from the patient and nurse perspective.

Methods: Twenty-five nurses and 29 patients completed questionnaires at four times throughout the three-month study

period, rating their confidence levels about BH cannulation issues. Patients also provided information on the pain of the cannulation

and the frequency of cannulation complications. Nurses documented data on arterial and venous pressures, and hemostasis

times. Patient charts were also reviewed for complications requiring extensive interventions such as AVF repair or Central

Line Catheter (CVC) placement. !e cost of providing the BH cannulation was also examined.

Results: At the end of the study, it was noted that cannulation pain was statistically reduced with both the arterial (p = .002)

and venous (p = .010) needles, and vessel pressures and hemostasis times were decreased slightly or stayed the same throughout the

study. !e frequency of access infections, however, increased, although not significantly. Using a 10-point Likert scale in which

a score of $ 8 indicates a high level of confidence, 77.5% of nurses and 73.9% of patients reported a high level of confidence in the

nurses’ abilities to use the BH technique effectively. In terms of expense, no significant changes were noted in frequency of

procedures required for AVF repair with the BH cannulation, although an increase of approximately $358.80 per patient per

year for BH supplies was noted.

Conclusion: BH cannulation did provide significant improvements. However, the increase in infection rate was an issue

of concern. !e additional cost of the BH procedure should be weighed against the positive outcomes realized.