Objective: This poster presents an evaluation of the buttonhole technique for cannulation, which we introduced into our Renal Dialysis Unit several years ago, and which we continue to use. This particular technique is very useful in patients with very short arterio-venous fistula access, and in patients with maturing and fragile access sites.

Method: After writing an evidence-based procedure, nurses were educated and assisted to attain the necessary expertise. There was some initial staff hesitancy, despite the use of a consultative process. Twenty months after the introduction of the technique, a written questionnaire about the satisfaction with the outcomes from the use of the buttonhole technique was devised and administered to all nurses and patients involved.

Results: Patients overwhelmingly supported the procedure because there was less pain; they felt less anxious; cannulation was quicker, with fewer ‘missed cannulations’; and they preferred the appearance of the cannulation sites. Nurses indicated that they had overcome their initial resistance, because they themselves felt less anxious and perceived that the patients also were less anxious; and that problems associated with cannulation were markedly reduced.

Conclusion: Importantly, both nurses and patients reported that the buttonhole technique increased the ease and decreased the discomfort associated with access cannulation. We continue to explore strategies to assist us to overcome the requirement to have the same nurse cannulate a patient while the cannulation tunnel forms, which can span several weeks to ensure access is well-established. One such strategy has been the creation of the Renal Access Coordinator nurse role.