Randomized controlled trial protocol on buttonhole cannulation: A technique to reduce arteriovenous fistula access complications

This multicenter, prospective, open-label randomized controlled trial will be undertaken to determine whether or not the buttonhole cannulation technique in new and established hemodialysis fistula reduces complications and prolongs access life compared to usual practice. A total of 70 subjects will be recruited for this study. Subjects randomized to the buttonhole group will have their fistula cannulated by the same staff member for 2-4 weeks at the same angle and direction with sharp needles. Once the tunnel is developed, blunt needles will be used. The control group will continue with usual practice (rope ladder rotation technique). Measurement of treatment effects will include: (1) quality of life; (2) pain assessment of cannulation; (3) lignocaine use; (4) intradialytic blood flow rate and venous and arterial pressures; (5) dialysis adequacy; (6) cannulation proficiency; and (7) hemostasis time. This study has been designed to provide evidence to help renal clinicians and their hemodialysis patients determine the optimal cannulation technique for prevention of fistula access complications.