Buttonhole cannulation in adult patients on hemodialysis: an increased risk of infection?

In the U.S., the rope-ladder technique for cannulating arteriovenous fistulas has been the technique of choice in patients on hemodialysis. Recently, the buttonhole cannulation technique has been gaining popularity. Based upon review of the literature and developments in clinical practice, an important question is posed regarding infection rates in those utilizing this technique. This article discusses those findings, presents a change in practice, and provides recommendations for practice.