Table 1.

Standardizing buttonhole cannulation: risk factors for infection and suggested strategies for mitigation

Risk Factors for Buttonhole Cannulation InfectionPossible Strategy to Mitigate the Risk FactorsComment
Poor patient selectionDevelop uniform criteriaRequires collaboration of expert workgroups
Improper technique of creation of BHC trackCan be standardized using devices instead of sharp needlesRequires research and device approval, could be expensive, although BSI reduction will save costs
Poor skin antisepsisDevelop and follow strict protocolRequires education and auditing for consistency
Improper scab removalDevelop and follow strict protocolRequires education and auditing for consistency
Poor cannulation techniqueNeed to self-cannulate or use single operatorHaving single operator in a dialysis unit is logistically difficult
Post-cannulation site careUse mupirocin topically, use correct dressing techniqueRequires validation in randomized, controlled trials
Improper use of PPEStandardize use of masks and glovesRequires education and auditing for consistency
Nasal carriage of Staphylococcus in patient and operatorConsider intranasal mupirocin applicationExpensive, logistically challenging
  • Careful patient selection, rigorous education, and frequent periodic auditing of technique will remain essential. BHC, buttonhole cannulation; BSI, blood stream infection; PPE, personal protective equipment.