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Title: Rope-ladder and buttonhole needling techniques and associated arterio-venous fistula access site infections
Authors: Spiteri, Kimberley
Keywords: Hemodialysis
Fistula, Arteriovenous
Kidneys -- Diseases
Chronic renal failure
Issue Date: 2016
Abstract: Objective: Rope ladder and buttonhole needling are two different techniques used to obtain vascular access for haemodialysis. Locally, only rope ladder needling technique is used due to the lack of local protocols based on current evidence. It was identified locally that a number of complications were arising to AVF accesses; subsequently one must ensure that what is being practiced locally is safe and the best option. The purpose of this study was to identify whether rope ladder needling is better than buttonhole needling in reducing the rate of access site infections. Research Question: In adult end-stage renal failure patients on haemodialysis with arterio-venous fistula access, is rope-ladder better than buttonhole needling in reducing access site infections? Method: A search strategy was implemented using the University of Malta HyDi database, Pubmed and Google scholar. This led to the identification of 3 systematic reviews, 3 randomized controlled trials, 4 prospective cohort studies and a retrospective cohort study. This search included a set of inclusion and exclusion criteria to minimize selection bias, studies included were those in the English or Maltese language whose participants were adults undergoing haemodialysis using an AVF access. These studies included comparison of buttonhole and rope ladder needling and comparison of infection rates. Combinations of relevant keywords were also utilized in identifying the 11 research studies selected. These were appraised using the AMSTAR tool for systematic reviews and the CASP tools for RCTs and cohort studies. Results: The overall result of the dissertation remains inconclusive due to conflicting outcomes extracted from the number of studies which have been reviewed. Conclusion: This dissertation found mixed results from the selected research studies. However, there was a general consensus that rope ladder needling does not increase the risk of infection. To conclude, the answer to the PICO question whether rope ladder needling is superior to buttonhole needling still remains inconclusive. This dissertation recommends further larger scale studies with well-defined outcomes to properly assess the strengths and limitations of rope ladder and buttonhole needling techniques.
Appears in Collections:Dissertations - FacHSc - 2016

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