Abstract: 【Abstract】Objective To explore the procedure and the effect of blunt needle puncture to autogenous arteriovenous fistulas in order to provide a guidance for clinical practice. Methods We retrospectively summarized 48 hemodialysis patients treated with buttonhole puncture to arteriovenous fistulas for blood access, and analyzed the tunnel formation, the technique of blunt needle puncture and the management of obstacles during puncture. Results Blood access was successfully performed in 43 of the 48 patients using buttonhole puncture method of blunt needles. Two of them had embolisms in fistulas and underwent another arteriovenous fistula surgery in the contralateral limb. Ladder puncture was then used. Infections occurred in 3 patients; the symptoms disappeared after the change to ladder puncture in one cases, and pseudo-tunnel formation was found in 2 cases and ladder puncture was then used. Conclusion The critical techniques for buttonhole puncture include tunnel formation, the time for the replacement of sharp needle puncture to blunt needles
puncture, procedures for blunt needle puncture, and taking off the scars. In patients with pseudo-aneurysm on fistulas, buttonhole puncture should be carefully manipulated to establish a tunnel far from the pseudo-aneurysm. When blunt needle puncture is interrupted and has to be reused, the original tunnel should be punctured several times with a sharp needle and then a blunt needle is used for the puncture. When infection occurs at the puncture site, local treatment with iodophor is used 3 times daily and this site can be used until the infection disappears completely. When obstacles happen during blunt needle puncture, the puncture must be stopped to explore the causes before continuing the manipulation. When hematoma forms, the puncture site must be changed. When bleeding at the puncture site occurs, intervention and investigation of the bleeding cause must be immediately conducted.

Key words: Blunt needle, Buttonhole puncture, Arteriovenous fistula, Hemodialysis