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Cannulating AV Fistulae - The Buttonhole Technique


© 1997 Andrew Lundin, M.D. All rights reserved. Reproduced with permission.


How does the buttonhole work?


It means using the same exact site over and over so that an almost

painless needle path or tunnel forms. As I said earlier, I have three

arterial and three venous sites. They are paired to all maximum distance

between the intake of blood and the return. If the tissue around the

hole remains undisturbed (not punctured) it remains strong and the

tunnel plugs up quickly when the needles are removed. I do not have

prolonged bleeding despite many years of use. If the needles are stuck

around the same area then the tissues are broken down and bulginess or

aneurysms can form.


I removed the scabs from sites that I will stick. I wash my hands and

access arm with soap and water thoroughly. Then I apply butadiene and

wait a few minutes for it to dry, then alcohol and let it dry before

sticking. I have not had a single access infection in the many years of



I do not believe this technique should be used on grafts. Does anyone

have any successful experience?


Peter Lundin, M.D.


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