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As a patient on dialysis for the past 25 years, I have often been encouraged to consider using buttonholes for fistula cannulation. Reduced pain, less risk to my fistula, and greater involvement in my dialysis care have all been highlighted as potential advantages. As a patient, I am well aware that many studies report positive outcomes with the buttonhole technique, whereas others warn about an increased risk of infection and questionable benefits to patients.Although I have not personally experienced buttonhole cannulation, my position is not definitively positive or negative on this practice. Rather, my goal is to illustrate the multiple challenges that patients face in adopting buttonhole cannulation. I am going to approach this topic from my personal perspective after more than two decades in a dialysis chair.Getting patients to understand why they need dialysis and the types of dialysis modality choices frequently monopolizes the initial conversations. Rarely is the cannulation technique presented as a priority to patients with newly diagnosed ESKD. To the patient going through the stages of grief of losing their kidney function, terms such as “rope ladder” and “buttonhole” have very little meaning. As such, the term “buttonhole” enters into the patient care plan usually well after hemodialysis has been started. …

The One Thing Clear About Buttonholes, is that Nothing is Clear About Buttonholes