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Original Article
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Korean J Med. 2014;87(5):574-578. Published online November 1, 2014.
DOI: https://doi.org/10.3904/kjm.2014.87.5.574
- 단일 혈액투석 기관에서 Buttonhole 천자의 경험
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최수정1, 조은희2, 이설형2, 오혜란2, 김종혜2, 박무용1, 김진국1, 황승덕1
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1순천향대학교 의과대학 내과학교실
2순천향대학교 부천병원 인공신장실
- Clinical Experience with Buttonhole Needling in a Single Hemodialysis Center
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Soo Jeong Choi1, Eun Hee Cho2, Sul Hyung Lee2, Hye Ran Oh2, Jong Hye Kim2, Moo Yong Park1, Jin Kuk Kim1, Seung Duk Hwang1
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1Division of Nephrology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
2Artificial Kidney Unit, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
- Corresponding author: Seung Duk Hwang ,Tel: +82-32-621-5166, Fax: +82-32-621-5018, Email: sd7hwang@schmc.ac.kr
- Received: December 31, 2013; Revised: March 3, 2014 Accepted: April 30, 2014.
- 목적: Buttonhole 천자는 혈액투석 시에 같은 부위를 천자해 천자가 쉽고, 통증이 적으며, 지혈이 빠른 장점들이 있어 국내에선 최근에 저자들에 의해 소개되었다.
방법: 2011년 7월부터 12월까지 buttonhole을 만들고 2013년 2월까지의 buttonhole 천자를 받았던 환자에게서 감염, 입원 및 동정맥루 사건을 조사하여, 동일 환자의 1년 전 ropeladder법으로 투석한 기간의 자료와 비교 분석하였다.
결과: 총 48명(남자 34명, 나이 49.4 ± 13.8세)이 buttonhole 술기를 시작하였고, 3명은 buttonhole을 만들지 못하였고, 3명은 이식, 1명은 전원으로 buttonhole 술기를 중단하였다. Buttonhole 천자를 지속한 41명의 15.1 ± 4.7개월 추적기간에 13명(29.2%)에서 감염이 발생하였고, 동정맥루 국소감염 5명, 폐렴 3명, 균혈증 2명, 봉와직염 1명, 간농양 1명, 골수염 1명 순이었다. 이들의 rope-ladder 천자 기간과 buttonhole 기간의 감염, 입원, 동정맥루 사건은 유의한 차이가 없었다.
결론: Buttonhole 천자는 rope-ladder천자에 비해 감염, 입원 및 동정맥루 사건의 유의한 차이가 없다.
߽ɾ :천자; 동정맥루; 혈액투석
- Abstract
- Background/Aims: The buttonhole technique, in which needle insertion during cannulation is always into the same site, confers advantages including ease of cannulation, ease of achieving hemostasis, and reduced pain compared with rope-ladder needling. We introduced the buttonhole technique in hemodialysis patients experiencing pain during needling. None of the disadvantages associated with the buttonhole technique, such as infection or access events, were observed, due to the short duration of the study.
Methods: Patients undergoing buttonhole needling were observed prospectively. Data were collected on the following parameters: infectious complications, hospitalizations and access events. We compared buttonhole and rope-ladder needling using baseline data.
Results: A total of 48 patients (34 males; mean age = 49.4 ± 13.8 years) were enrolled. Seven patients were excluded: in three patients, the buttonhole technique failed to form a tract, three others underwent kidney transplantation, and one was lost to follow-up. The remaining 41 patients were followed for 15.7 ± 4.7 months. Thirteen patients suffered infections, as follows: local infections (n = 5), pneumonia (n = 3), bacteremia (n = 2), cellulitis (n = 1), osteomyelitis (n = 1), and liver abscess (n = 1). There were no significant differences between the rope-ladder and buttonhole needling techniques in rates of infection, hospitalization or vascular access events.
Conclusions: The infection rate and access event frequency associated with buttonhole needling did not differ in relation to that of rope-ladder needling.
Keywords :Buttonhole cannulation, Arteriovenous fistula, Hemodialysis
