Abstract: Objective  To investigate the influencing factors for the intimal hyperplasia in arteriovenous fistula (AVF) in patients with buttonhole puncture for hemodialysis, so as to provide scientific basis for the intervention.  Methods  The patients using buttonhole puncture for hemodialysis in The First People’s Hospital of Changzhou during January 2021 to December 2021 were selected by the convenience sampling method. They were divided into intimal hyperplasia group and normal group as the binary dependent variables, and the general clinical information and relevant indexes of buttonhole puncture were used as the independent variables. Univariate analysis and unconditional logistic regression analysis were used to analyze the influencing factors for intimal hyperplasia. Receiver operating characteristic (ROC) curve was plotted to obtain the optimal critical value for predicting intimal hyperplasia.  Results  The incidence of intimal hyperplasia in the 85 patients using buttonhole puncture was 68.2%. Binary logistic regression showed that use time of the buttonhole (OR=1.059, 95% CI 1.004～1.116, P=0.036), normal vein diameter (OR=0.744, 95% CI 0.589～0.940, P=0.013) and infection (OR=7.460, 95% CI 1.685～33.033, P=0.008) were the influencing factors for intimal hyperplasia in AVF. ROC curve predicted that the optimal critical time for intimal hyperplasia was the use of the buttonhole for 10.5 months.  Conclusion The incidence of intimal hyperplasia in AVF is high at the puncture site of buttonhole, which is closely related to long-term use of the buttonhole, slender diameter of normal vein and infection. Clinical nurses should understand the indications of buttonhole puncture and the relationship between intimal hyperplasia and buttonhole puncture, take early intervention measures, and implement strict monitoring measures to prevent access complications caused by intimal hyperplasia in AVF.

Key words: Hemodialysis, Arteriovenous fistula, Buttonhole puncture, Intimal hyperplasia, Root cause analysis