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Sunday, July 15, 2012


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Roberta Mikles BA RN

this has to do with infection control techniques -- I remember when my father had an attempted buttonhole -- the staff did not remove the scab, even after another interventional nephrologist, who was involved with buttonholes, etc., gave an instructional class ---finally they did remove the scabs. However, I still hear patients stating the scabs are not removed -- therefore, bacteria in the scab is introduced into the bloodstream..

opinion of Roberta Mikles BA RN
Director, Advocates4QualitySafePatientCare


Should the initial results Stuart obtained in his home unit be duplicated with a significant reduction in infections, one of the biggest considerations against using buttonhole cannulation will evaporate.
Medsempire Muhammad

Peter Laird, MD

That is the great hope of Stuart's study he is now conducting in several centers in the US, Canada and Europe I believe. Buttonhole cannulation should be the standard of care in-center and at home for all patients with an appropriate access. I believe that this is the beginning of research into making that a reality for all patients.


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Sharon Badger

One of the things I have noticed is that there is a lack of MD authored papers/articles concerning the buttonhole technique. Good or bad, many will not even consider the recommendation of this technique unless there is supporting documentation from licensed personnel on the topic. I do believe the problems seen with current buttonhole usage is a function of no or not enough teaching regarding the proper precautions to take when preparing the site. Please keep going on this.

Peter J. Tonkin

I have been using buttonholes for seven years now and totally agree that the current issue with the concern in using buttonholes is due to incorrect infection control. In my seven years I have never had an infection and never been admitted to hospital.. Five of these years were done at home, five times a week doing nocturnal, and the other two in hospital. I am still using the original buttonholes I created seven years ago and never missed a day.

I would recommend buttonholes to anyone considering home dialysis or nocturnal just as my mentor did to me when I first started dialysis and he dialysed for over 35 years.

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