Abstract: Objective To compare the clinical effects between buttonhole (BH) puncture by blunt needle and rope ladder (RL) puncture by sharp needle in maintenance hemodialysis (MHD) patients. Methods Patients with native arteriovenous fistula (AVF) for MHD treated in our blood purification center from Feb. 2016 to Feb. 2017 (13 months) were followed up. There were 11 patients punctured by BH technique (group BH) and 15 patients punctured by RL technique (group RL) during hemodialysis. The ratio of infection, success of puncture, bleeding of puncture point, average effective blood flow volume, and urea clearance index
(Kt/V) were compared between the two groups. Results No infection events happened in both groups. There were 2,073 times puncture in group BH and 2,392 times puncture in group RL. The successful puncture rate in group BH was significantly higher than that in group RL (99.5% vs. 96.0%, χ²=57.591, P＜0.001). The incidence of bleeding in group BH was significantly less than that in group RL (2.9% vs. 4.1%, χ²=5.008, P=0.029). There were no significant differences in average effective blood flow volume (285.2±21.1 ml/min vs.300.2±24.6 ml/min, t=-1.673, P=0.107) and Kt/V (1.4±0.2 vs. 1.5±0.2, t=-0.256, P=0.800). Conclusion BH technique using blunt needle for AVF puncture shows the benefits in terms of higher puncture success rate, less bleeding rate and lower risk of infection.

Key words: Hemodialysis, Arteriovenous fistula, Puncture, Blunt needle, Infection