Change Concept 1
Routine CQI
 

Change Concept 2
Referral to nephrologist
 

Change Concept 3
Referral to surgeon
 

Change Concept 4
Surgeon selection
 

Change Concept 5
Surgical approaches
 

Change Concept 6
Secondary AVF
 

Change Concept 7
AVF placement in patients with catheters
 

Change Concept 8
Cannulation training
 

Change Concept 9
Monitoring and maintenance
 

Change Concept 10
Education for care givers and patients
 

Change Concept 11
Outcomes feedback
 

Change Concept 12
Modify hospital systems
 

Change Concept 13
Patient self-management
 

Change Concept 8

 

Cannulation training for AV fistulas: Site Rotation and Buttonhole Techniques

  • Facility uses best cannulators and best teaching tools (e.g., videos) to teach AVF cannulation to all appropriate dialysis staff.
  • Dialysis staff use specific protocols for initial dialysis treatments with new AVFs and assign the most skilled staff to such patients.
  • Facility offers option of self-cannulation to patients who are interested and able.

     

Prevent fistulae from being destroyed by inexperienced staff. Discuss the basics of needle cannulation with all staff.

 

Changes for Improvement:

 

Use Experienced Staff and Teaching Tools to Train All Appropriate Dialysis Staff on AVF Cannulation

Identify the experienced cannulators on your staff; make sure they are available to cannulate all new fistulae and to train inexperienced staff.  Identify and make available to your staff appropriate teaching tools.

 

Use Protocols for Initial Dialysis Treatments with New AVF Patients

Dialysis staff should develop and use a specific protocol for initial dialysis treatments with new AV fistula patients and assign the most skilled staff to such patients.

 

Teach Self-Cannulation to Patients Who Are Interested and Able

Facilities should offer the option of self-cannulation to patients who are interested and able.

 

Related Tools
 

Cannulation of the AV Fistula Training Videos

A video series to educate dialysis facility staff on successfully cannulating AV fistulas.  
 

Cannulation of New Fistula Policy and Procedure 

A sample policy and procedure statement on successfully cannulating new arteriovenous fistulae and preventing infiltration.
Revised 07/11

 

Clamp Usage Policy and Procedure

A sample policy and procedure statement on when and how to use clamps in dialysis settings.

 

Self-Cannulation of Vascular Access Procedures

An example procedure statement on successful self-cannulation of vascular access.

 

Training Checklist for Self-Cannulation 

A checklist for patients who will be self-cannulating
Revised 06/11

 

Tandem Hand Technique for Self-Cannulation

This technique has been identified as a Best Practice for teaching patients to self-cannulate.  Reprint permission has been granted by ANNA's Nephrology Nursing Journal.

 

Improving AVF Cannulation Skills

Article by Lynda K. Ball cites evidence-based, best demonstrated practices to utilize in improving individual cannulation techniques.  Reprint permission has been granted by ANNA's Nephrology Nursing Journal.

 

Sample Dialysis Facility Guidelines for Rating & Improving Staff Cannulation Competency 

A tool for determining and developing the cannulation competency of dialysis staff
Revised 09/09

 

AVF Quick Reference Guide

This is an easy-to-use reference document that describes the maturation process, and guidelines for assessment and monitoring of AV fistulas.

 

Fistula First Training Module

An interactive module designed for training both patients and staff regarding the benefits and care of AV fistulae, how to encourage AV fistulae as a primary access, and how to conduct cannulation training.

 

Buttonhole Tools

 

Improving Buttonhole Cannulation

WebEx recording from April 12, 2011
 

Hubbing article

Article by Lynda K. Ball and Stuart Mott identifies a new phenomenon involving the Buttonhole Technique, and a strategy for prevention. Reprint permission has been granted by ANNA's Nephrology Nursing Journal.
 

Buttonhole Infections

Article by Lynda K. Ball, provides an evidence-based overview of complications that are leading to incrased infection rates with the Buttonhole Technique. Reprint permission has been granted by ANNA's Nephrology Nursing Journal. 

 

Buttonhole ID Card

This wallet ID card was created by the Northwest Renal Network for patients who travel, are hospitalized, or require access intervention. The Northwest Renal Network also offers additional materials for download available through the link above.

 

The Cushion Cannulation Technique

This techique allows for stabilization of an upper arm access to enable successful cannulation using both site rotation and buttonhole technique methods.  Reprint permission has been granted by ANNA's Nephrology Nursing Journal

Cannulation of Upper Arm Fistulas

This technique has been identified asa Best Practice for cannulating buttonhole sites, as well as any difficult upper arm site.  Reprint permission has been granted by ANNA's Nephrology Nursing Journal.

 

The Touch Cannulation Technique

This technique has been identified as a Best Practice for cannulating buttonhole sites.  Reprint permission has been granted by ANNA's Nephrology Nursing Journal.

 

Constant Site (Buttonhole) Method of Needle Insertion for Hemodialysis

This historical paper describes the orgin of the buttonhole method, early results, and the reasons why the method has not gained widespread popularity in U.S. hemodialysis centers.

 

The Buttonhole Technique for AVF Cannulation

Article by Lynda Ball, provides an evidence-based educational tool for nephrology nurses to enable them to perform and troubleshoot the buttonhole cannulation technique for accessing an AV fistula.  Reprint permission has been granted by ANNA's Nephrology Nursing Journal.

 

Multi-Center Perspective of the Buttonhole Technique in the Pacific Northwest

Reprint permission has been granted by ANNA's Nephrology Nursing Journal.

 

Buttonhole Damage from Sharp Needles

A short PowerPoint Presentation that explains the damage that using sharp needles can cause to buttonhole sites after transitioning from teh sharps creation phase to utilizing blunt needles.

Handout

 

Buttonhole Technique Fact Sheet 

A handy one page guide to the Buttonhole Technique. 
Revised 08/11

 

The Salvage of Aneurysmal Fistulae Utilizing a Modified Buttonhole Cannulation Technique and Multiple Cannulators

The landmark research paper by Marticorena et al. (2006) from St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada, describing the creation of buttonhole sites, published in Hemodialysis International.

 

Buttonhole Cannulation Skills Checklist

This is a comprehensive competency checklist that hsoudl be utilized for any Buttonhole Cannulation program.  The checklist can be used in conjunction wiht a provider's buttonhole cannulation policy and procedure.

 

Bibliography of Buttonhole Articles

This is a comprehensive, up-to-date list of educational and research articles published on the topic of Buttonhole Cannulation.

Copyright 2009 by Fistula First  |