Moist Wound Healing and Eutectic Mixture of Local Anesthetics Cream for Clean Buttonhole Cannulation - An Infection Reduction Strategy

Sep 30, 2026

Uploaded by Terk

Background The buttonhole cannulation technique in hemodialysis offers benefits but has been criticized for potentially increasing local and systemic infections, including sepsis and death. Prior comparisons with the rope ladder method overlooked how scab removal at the puncture site may change infection risk. The clean buttonhole method combines moist wound healing, thorough washing, and eutectic local anesthetic cream to soften and eliminate scabs. Methods An observational study followed maintenance hemodialysis patients from June 2020 to July 2024 in Japan, tracking infection rates in clean buttonhole versus sharp needle groups. Results Very low localized infections were observed in the clean group and were characterized by mild redness without pain. Conclusions The clean buttonhole approach shows a comparable infection risk profile, suggesting improved patient safety and comfort, with larger multicenter validation needed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Key Points

Abstract

Background

Methods

Results

Conclusions

Introduction

Clinical Research Moist Wound Healing and Eutectic Mixture of Local Anesthetics Cream for Clean Buttonhole Cannulation An Infection Reduction Strategy Kazuhiko Shibata , 1 Shigeki Toma,2 Shigeru Nakai ,3,4 Masumi Yamamoto, 1 and Kouichi Tamura 4 Key Points c In buttonhole cannulation, where scabs are forcibly removed, the infection rate is higher than that in the rope ladder method. c The clean buttonhole method enhances scab care by combining moist wound healing, thorough washing, and eutectic mixture of local anesthetics. c The buttonhole technique allows patients to maintain healthy skin, except for the two puncture sites. Abstract 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 5 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. Kidney360 6: 1762–1770, 2025. doi: [https://doi.org/10.34067/KID.0000000864](https://doi.org/10.34067/KID.0000000864) 1Toshin Clinic, Yokohama, Japan 2Toma Clinic, Chatan, Japan 3Faculty of Clinical Engineering Technology, Fujita Health University School of Health Sciences, Toyoake, Japan 4Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan Correspondence: Dr. Kazuhiko Shibata, email: [k.shibata@houshinkai.or.jp](k.shibata@houshinkai.or.jp) [Received:](Received: February 6)[ February 6](Received: February 6), 2025 Accepted: June 4, 2025 Published Online Ahead of Print: June 17, 2025 Copyright © 2025 The Author(s) . Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1762 [www.kidney360.org](www.kidney360.org Vol)[ Vol](www.kidney360.org Vol) 6 October, 2025 Introduction The buttonhole cannulation technique has been reported to offer several advantages in hemodialysis, such as reduction in cannulation errors, decrease in pain, and prevention of hematoma fo

FAQs

What problem does the study target in buttonhole cannulation?

The study targets the concern that buttonhole cannulation may increase local and systemic infections, potentially including sepsis and death, especially related to how scabs at the puncture site are handled.

How is the clean buttonhole method implemented in the study?

It combines moist wound healing, thorough washing, and an eutectic mixture of local anesthetics cream to soften and efficiently remove buttonhole scabs before the next hemodialysis.

What were the main infection findings between clean buttonhole and sharp needle groups?

Among 33,137 punctures using the clean buttonhole technique, only one localized infection was reported with mild redness and no pain. The sharp needle group showed multiple infections, and overall local infection rates were similar without a statistically significant difference (P = 0.86).

Why do the authors believe further research is needed?

They conclude the clean buttonhole method has a comparable infection risk profile but requires larger, multicenter populations to validate results and assess broader clinical applications.

Sep 30, 2026

Uploaded by Terk