Application of blunt needle buttonhole reconstruction technique and escharectomy tool in autogenous arteriovenous fistula puncture
Objective:To explore the related problems and intervention methods of blunt needle buttonhole technique in the long-term of autologous arteriovenous fistula puncture and analysis its effect,so as to provide guidance and refer-ence for clinical nursing in hemodialysis.Methods:Clinical data of 267 hemodialysis patients who received arteriovenous fistula puncture with the blunt needle buttonhole technique in yijishan hospital,the First Affiliated Hospital of Wannan Medical College were reviewed.Reasons for the formation of the buttonhole false tunnel,the methods and skills of remo-ving the scab at the buttonhole point were summarized,and risk factors of the internal fistula infection during the button-hole puncture were analyzed to provide prevention methods.Results:Among the 267 patients,189 patients underwent blunt needle puncture with both arterial and venous needles,and 78 patients underwent blunt needle puncture with only one needle of arterial puncture or venous puncture.Tunnel reconstruction with buttonhole was performed in 17 cases.From July to September 2019 and October to December 2019,a disposable No.16 sterile round blunt needle and a disposable No.12 sterile beveled sharp needle were respectively used to remove the scabs after wet compressing the punctured sites.There was no statistical difference in the occurrence of bleeding between the two methods(P＞0.05);However,the degree of difficulty in removing scabs was statistically higher in the former than in that the latter(P＜0.001),and the frequency of infection was statistically higher in the former than that in the latter(P＜0.05).Conclusion:When false tunnel formed and scab hard to remove in buttonhole puncture,reconstruction of the original buttonhole tunnel with sharp needle and re-move the scab after wet compression of the puncture hole by using disposable No.12 sterilized inclined needle can improve the success rate of vascular puncture and avoid infection at the puncture site.It has certain clinical value in the mainte-nance of long-term vascular access in hemodialysis patients and is worth of popularizing.
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