Reframing the Role of Buttonhole Cannulation (BHC) in the Home Hemodialysis (HHD) and Self-Care Settings: Outcomes of BHC as a Primary Technique in a Large Single-Center HHD Program
- Home Dialysis - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
- Zafar, Waleed, Geisinger Medical Center, Danville, Pennsylvania, United States
- Bermudez, Maria, Geisinger Medical Center, Danville, Pennsylvania, United States
HHD remains underutilized in the U.S. Fear of needle insertion is one of the main patient barriers for widespread adoption of HHD. BHC, once considered the preferred method for self-cannulation given patient- and fistula-friendliness, has fallen out of favor due to concerns about infectious complications. The quality of evidence concerning potential risks of BHC is low. We describe experience from a single center HHD program regarding utilization of BHC technique.
Patients currently enrolled in the HHD program were surveyed regarding the use of BHC. Since the program predominantly utilizes BHC, we also evaluated the incidence of bacteremia in all patients enrolled in the HHD program between 2008 and 2022.
Between 2008 and 2022 a total of 76 patients were ever enrolled in the HHD program at a single center of whom 18 (23.7%) were currently active, 13 were successfully transplanted, 19 transitioned to in-center hemodialysis and 23 died. No episodes of bacteremia were documented in the HHD program over this period. 14 of the 18 currently active patients who had arteriovenous fistulas were surveyed and 13 of them used BHC technique. All but 2 patients did short daily HHD with remaining two doing nocturnal HHD. Demographics and results from the survey are presented in table 1.
Our 14-year single center experience with BHC has helped develop key elements for the successful implementation of this technique: a single cannulator per fistula, multidisciplinary patient-centered selection, longitudinal education, strict infection control, and reliable nursing support. These have shown to be important in patient and care partner empowerment as well as low incidence of infectious and noninfectious complications.