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Enfermería Nefrológica

versão On-line ISSN 2255-3517versão impressa ISSN 2254-2884


BLANCO MAVILLARD, Ian; RODRIGUEZ CALERO, Miguel Ángel  e  SANCHEZ ROJAS, Cynthia. Evaluation of complications of arteriovenous fistula for hemodialysis according to the puncture technique. Enferm Nefrol [online]. 2017, vol.20, n.2, pp.167-177. ISSN 2255-3517.


The arteriovenous fistula is the standard vascular access for the treatments in hemodialysis, punctured periodically three times per week. There are three types of puncture techniques: ladder, puncture area and buttonhole. Conventional techniques cause great morbidity in the medium and long term, however, a priori, the buttonhole technique is associated to the improvement of those problems.


To compare the buttonhole puncture technique with respect to conventional techniques for vascular access cannulation in the treatment of hemodialysis, depending on the degree of pain associated with the technique, associated infection rates and the repercussion on vascular access survival.

Material and Method:

Narrative bibliographic review. Experimental and observational studies in English and Spanish published between 2010 and 2015 were included, comparing the conventional puncture technique versus the Buttonhole puncture technique. Initial selection by title and summary. The CASPe and STROBE scales were used for the methodological evaluation.


1.827 studies were identified, of which 13 were selected after the critical evaluation process. The heterogeneity of results does not allow to affirm improvements of any of the techniques analyzed in puncture pain or survival of the access, nevertheless, it is associated an increase of infectious events with the Buttonhole technique.


Any arguments have been found to ensure that Buttonhole technique can be considered as first choice due to the heterogeneity of the measurement methods of the reviewed studies.

Palavras-chave : hemodialysis; arteriovenous fistulae; catheterization; infection; pain; survival.

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