Objective: In 2005 the first paediatric haemodialysis unit for Queensland opened at the Royal Children’s Hospital (RCH), Brisbane, Australia. March 2006 the first haemodialysis patient required Arterio Venous Fistula (AVF) cannulation. A daunting prospect with only one experienced senior nurse. The most suitable technique for cannulation was sought for the adolescent patient group at this fledgling unit.

Method: After an extensive review of the literature, it became evident that the buttonhole cannulation technique would be beneficial to the patient group and the model of nursing care. The nursing standards were written for the buttonhole cannulation and education of the dialysis team commenced. The only senior haemodialysis nurse created the buttonhole tracks.

Results: Two adolescents have used the buttonhole cannulation technique.
The first a 14-year-old male had 21 patient months without incident before transplantation. The second, a 15-year-old female, commenced using the buttonhole technique in April 2007. This patient was identified as a great candidate for self-cannulating and future home training. She was subsequently transferred to an adult unit and in 2008 she commenced haemodialysis at home. Each case experienced no infections or failures from the cannulation technique.

Conclusion: The buttonhole cannulation method is worthy of consideration for adolescent patients with AVF. The main patient benefit appears to be a manageable cannulation experience. The procedure also enables nurses with limited cannulation skills to conduct dialysis sessions. The technique has also enabled us to empower our patients by giving them the option of taking over the cannulation procedure.