{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:31:56Z","timestamp":1786480316339,"version":"build-2736575974"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2025,10]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n In buttonhole cannulation, where scabs are forcibly removed, the infection rate is higher than that in the rope ladder method.<\/jats:p>\n <\/jats:list-item>\n \n The clean buttonhole method enhances scab care by combining moist wound healing, thorough washing, and eutectic mixture of local anesthetics.<\/jats:p>\n <\/jats:list-item>\n \n The buttonhole technique allows patients to maintain healthy skin, except for the two puncture sites.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n The buttonhole cannulation technique is recognized for its advantages in hemodialysis, including reduced cannulation errors, decreased pain, and prevention of hematoma formation. However, it has been criticized for possibly increasing the risk of local and systemic infections, including sepsis and death. Prior studies have shown the infection risks associated with the buttonhole technique compared with the rope ladder technique, but the role of scab removal methods at the puncture site has been overlooked. The clean buttonhole method was developed on the basis of softening and removing buttonhole scabs with liquid soap in home hemodialysis, incorporating moist wound-healing treatment, thorough washing, and eutectic mixture of local anesthetics cream to efficiently eliminate scabs.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This observational study included patients undergoing maintenance hemodialysis at Toshin Clinic in Yokohama, Japan, from June 2020 to July 2024. Infection rates were documented in both the clean buttonhole and sharp needle groups. Statistical tests were used to compare the incidence of local infections between the groups.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 33,137 punctures performed using the clean buttonhole technique, only one localized infection was reported, characterized by mild redness without pain. By contrast, the sharp needle group experienced multiple infections with the rope ladder technique. The local infection rate was 0.030 cases per 1000 punctures in the clean buttonhole group compared with 0.025 cases per 1000 punctures in the sharp needle group, with no statistically significant difference observed (\n P<\/jats:italic>\n = 0.86).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The clean buttonhole method demonstrates a comparable infection risk profile with traditional sharp needle techniques. These findings indicate that this method may enhance patient safety and comfort in hemodialysis. Further research with larger, multicenter populations is needed to validate these results and assess broader applications in various clinical settings.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000000864","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T12:02:43Z","timestamp":1750161763000},"page":"1762-1770","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Moist Wound Healing and Eutectic Mixture of Local Anesthetics Cream for Clean Buttonhole Cannulation"],"prefix":"10.34067","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3339-6473","authenticated-orcid":false,"given":"Kazuhiko","family":"Shibata","sequence":"first","affiliation":[{"name":"Toshin Clinic, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shigeki","family":"Toma","sequence":"additional","affiliation":[{"name":"Toma Clinic, Chatan, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3493-9887","authenticated-orcid":false,"given":"Shigeru","family":"Nakai","sequence":"additional","affiliation":[{"name":"Faculty of Clinical Engineering Technology, Fujita Health University School of Health Sciences, Toyoake, Japan"},{"name":"Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masumi","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Toshin Clinic, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0660-5372","authenticated-orcid":false,"given":"Kouichi","family":"Tamura","sequence":"additional","affiliation":[{"name":"Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"issue":"suppl 9","key":"B1-20251101","doi-asserted-by":"crossref","first-page":"S54","DOI":"10.5301\/jva.5000349","article-title":"Update on cannulation techniques","volume":"16","author":"Twardowski","year":"2015","journal-title":"J Vasc Access."},{"issue":"1","key":"B2-20251101","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1093\/ndt\/gfp420","article-title":"Buttonhole needling of haemodialysis arteriovenous fistulae results in less complications and interventions compared to the rope-ladder technique","volume":"25","author":"van Loon","year":"2010","journal-title":"Nephrol Dial Transplant."},{"issue":"29","key":"B3-20251101","doi-asserted-by":"crossref","first-page":"e29597","DOI":"10.1097\/MD.0000000000029597","article-title":"Effect of buttonhole cannulation versus rope-ladder cannulation in hemodialysis patients with vascular access: a systematic review and meta-analysis of randomized\/clinical controlled trials","volume":"101","author":"Wang","year":"2022","journal-title":"Medicine (Baltimore)."},{"issue":"3","key":"B4-20251101","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1111\/j.1755-6686.2009.00103.x","article-title":"\u2018Everyone should buttonhole\u2019: a novel technique for a regional Australian renal service","volume":"35","author":"Hartig","year":"2009","journal-title":"J Ren Care."},{"issue":"suppl 2","key":"B5-20251101","first-page":"S208","article-title":"Buttonhole technique better than area puncture technique on hemostasis and pain associated with needle cannulation","volume":"95","author":"Sukthinthai","year":"2012","journal-title":"J Med Assoc Thai."},{"issue":"5","key":"B6-20251101","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.xkme.2019.07.007","article-title":"Staphylococcus aureus bacteremia risk in hemodialysis patients using the buttonhole cannulation technique: a prospective multicenter study","volume":"1","author":"Glerup","year":"2019","journal-title":"Kidney Med."},{"issue":"3","key":"B7-20251101","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1053\/j.ajkd.2010.10.045","article-title":"Infectious complications following conversion to buttonhole cannulation of native arteriovenous fistulas: a quality improvement report","volume":"57","author":"Labriola","year":"2011","journal-title":"Am J Kidney Dis."},{"issue":"10","key":"B8-20251101","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.2215\/CJN.02730312","article-title":"A randomized trial comparing buttonhole with rope ladder needling in conventional hemodialysis patients","volume":"7","author":"MacRae","year":"2012","journal-title":"Clin J Am Soc Nephrol."},{"issue":"5","key":"B9-20251101","doi-asserted-by":"crossref","first-page":"322","DOI":"10.34067\/KID.0000602019","article-title":"Should buttonhole cannulation of arteriovenous fistulas be used? 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