Twardowski ZJ
Constant site (buttonhole) method of needle insertion
for hemodialysis
Dial Transplant
(Oct) 24:559-560 1995
The usual strategy of placing needles in AV accesses is to use the "rope
ladder" approach, moving the needle puncture sites up and down the graft to
avoid placing all of the sites in one or two areas. The latter weakens the
access and predisposes to aneurysm formation. Twardowski describes another
approach first described in Poland in the 70's; placing the needle into
exactly the same tract every time "buttonhole approach". This method has
been assessed in detail only for fistulas, and works best using a non-
siliconized, slightly dull needle, to avoid leakage and cutting a new tract,
respectively. Both needles are inserted in a downstream direction. The
method has not been tried extensively in the U.S. for grafts, but the author
thinks it should be tested with new thicker and stronger grafts. It may be
ideal for home hemodialysis patients, as it minimizes the trauma and pain of
needlesticks.
(Daugirdas)
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Vascular Access: graft/fistula