Moist Wound Healing and Eutectic Mixture of Local Anesthetics Cream for Clean Buttonhole Cannulation

Key Points In buttonhole cannulation, where scabs are forcibly removed, the infection rate is higher than that in the rope ladder method. The clean buttonhole method enhances scab care by combining moist wound healing, thorough washing, and eutectic mixture of local anesthetics. The buttonhole technique allows patients to maintain healthy skin, except for the two puncture sites. Background 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. Methods 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. Results 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 ( P = 0.86). Conclusions 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.