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A comparison of the buttonhole and rope-ladder AVF cannulation techniques and infection rates within the SCOPE collaborative

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Abstract

Background

Studies regarding hemodialysis (HD) arteriovenous fistula (AVF) cannulation in adults indicate a higher risk of infection with the buttonhole (BH) technique compared to the rope-ladder (RL) technique. Pediatric data on this issue is sparse.

Methods

We compared infection rates within the Standardizing Care to Improve Outcomes in Pediatric End stage kidney disease (SCOPE) centers performing BH cannulation versus RL cannulation of AVF. Generalized linear mixed modeling was used to assess differences in access-related blood stream infection (BSI) and access site infection (ASI) rates between the centers.

Results

Data was available from 211 AVF enrollments among 210 children. There were 61 AVF enrollments at 6 BH centers and 150 enrollments at 13 RL centers. Demographics were similar between the two groups. There were 12 total infections in 3383 patient months. BH centers had 3 infections (0 BSI, 3 ASI) and RL centers had 9 infections (5 BSI, 3 ASI). Mean [95% confidence interval] infection rates per 1000 patient months were not different between BH and RL centers (BH: 3.1 [0.6,15.6], RL: 3.2 [1.3,9.4], p = 0.947). A survey was also completed by the BH centers to describe their BH practices. The BH procedure at the majority of sites was characterized by a small patient/nurse ratio and strict antiseptic protocols.

Conclusions

This data provides evidence of a low BSI rate associated with BH cannulation in pediatric HD patients. Further studies are needed to better delineate the differences in the pediatric and adult experience with the BH cannulation technique.

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Nephrology, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, MO, USA

    Heather A. Morgans & Bradley Warady

  2. Children’s Hospital Association, Lenexa, KS, USA

    Heidi Gruhler De Souza & Troy Richardson

  3. Cincinnati Children’s Hospital Medical Center, Division of Nephrology, University of Cincinnati Department of Pediatrics, Cincinnati, OH, USA

    Donna Claes

  4. Department of Pediatrics, Division of Nephrology, Washington University in St Louis, St Louis, MO, USA

    Kevin T. Barton

  5. Department of Pediatrics, Division of Nephrology, University of California San Francisco, San Francisco, CA, USA

    Marsha Lee

  6. Department of Pediatrics, Division of Nephrology and Dialysis, Akron Children’s Hospital, Akron, OH, USA

    Shefali Mahesh

  7. Department of Pediatrics, Division of Nephrology, Omaha Children’s Hospital and Medical Center, University of Nebraska Medical Center, Omaha, NE, USA

    Melissa Muff-Luett

  8. Department of Pediatrics, Division of Nephrology, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    Sarah J. Swartz

  9. Department of Pediatrics, Division of Nephrology, Johns Hopkins Children’s Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Alicia Neu

Authors
  1. Heather A. Morgans
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Correspondence to Heather A. Morgans or Bradley Warady.

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Morgans, H.A., De Souza, H.G., Richardson, T. et al. A comparison of the buttonhole and rope-ladder AVF cannulation techniques and infection rates within the SCOPE collaborative. Pediatr Nephrol 36, 3915–3921 (2021). https://doi.org/10.1007/s00467-021-05137-1

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  • DOI: https://doi.org/10.1007/s00467-021-05137-1

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