✅ History of Buttonhole Technique – MCQs
1. What is the buttonhole technique in hemodialysis?
A. A method of cannulating an arteriovenous fistula using the same site and angle to create a track
B. A technique to insert a central venous catheter
C. A way to access peritoneal dialysis catheters
D. A method of creating a new fistula
➡️ Answer: A. A method of cannulating an arteriovenous fistula using the same site and angle to create a track
2. When was the buttonhole technique first introduced or described?
A. Early 1970s
B. 1950s
C. 1990s
D. 2000s
➡️ Answer: A. Early 1970s
3. Who is credited with pioneering or popularizing the buttonhole technique?
A. Dr. Twardowski and colleagues
B. Willem Kolff
C. Belding Scribner
D. John Jacob Abel
➡️ Answer: A. Dr. Twardowski and colleagues
4. What was the main motivation behind developing the buttonhole technique?
A. To reduce pain and trauma associated with repeated needle sticks
B. To improve dialyzer efficiency
C. To eliminate the need for fistula creation
D. To reduce infection rates in peritoneal dialysis
➡️ Answer: A. To reduce pain and trauma associated with repeated needle sticks
5. The buttonhole technique involves creating a tunnel track by:
A. Repeated cannulation at the exact same site and angle over several sessions
B. Random cannulation at different sites
C. Using large bore needles only
D. Surgical creation of a tunnel under the skin
➡️ Answer: A. Repeated cannulation at the exact same site and angle over several sessions
6. What is a commonly reported benefit of the buttonhole technique?
A. Less pain during needle insertion
B. Increased blood flow rates
C. Higher dialysate purity
D. Faster dialysis sessions
➡️ Answer: A. Less pain during needle insertion
7. Which complication has been associated with the buttonhole technique compared to the traditional rope-ladder technique?
A. Higher risk of infection or tunnel tract infection
B. Higher rates of thrombosis
C. Lower dialysis adequacy
D. Increased vascular stenosis
➡️ Answer: A. Higher risk of infection or tunnel tract infection
8. In which patient population is the buttonhole technique often preferred?
A. Patients with difficult vascular access or painful cannulation
B. All newly created fistulas
C. Peritoneal dialysis patients
D. Patients with central venous catheters
➡️ Answer: A. Patients with difficult vascular access or painful cannulation
9. Which of the following is an alternative to the buttonhole technique for AV fistula cannulation?
A. Rope-ladder technique
B. Central venous catheter insertion
C. Peritoneal dialysis catheter placement
D. Surgical fistula ligation
➡️ Answer: A. Rope-ladder technique
10. Proper training and hygiene are essential to reduce which risk in buttonhole cannulation?
A. Infection
B. Bleeding
C. Thrombosis
D. Hypotension
➡️ Answer: A. Infection
11. The buttonhole technique is also known by what other name?
A. Constant-site cannulation
B. Rope-ladder cannulation
C. Stepladder technique
D. Random-site cannulation
➡️ Answer: A. Constant-site cannulation
12. The buttonhole technique was originally developed for patients using which type of vascular access?
A. Arteriovenous fistula (AVF)
B. Central venous catheter (CVC)
C. Arteriovenous graft (AVG)
D. Peritoneal dialysis catheter
➡️ Answer: A. Arteriovenous fistula (AVF)
13. How long does it typically take to establish a mature buttonhole track?
A. Approximately 6 to 10 consecutive dialysis sessions
B. Immediately after fistula creation
C. 1 to 2 weeks
D. More than 6 months
➡️ Answer: A. Approximately 6 to 10 consecutive dialysis sessions
14. What type of needles are typically used in buttonhole cannulation once the track is established?
A. Blunt needles
B. Sharp needles
C. Large bore needles only
D. Catheters
➡️ Answer: A. Blunt needles
15. Which of the following is a contraindication for using the buttonhole technique?
A. Infected or inflamed fistula site
B. Newly created fistula
C. Mature fistula with good blood flow
D. Patients with multiple prior cannulation sites
➡️ Answer: A. Infected or inflamed fistula site
16. Studies have suggested that the buttonhole technique may reduce:
A. Cannulation-related aneurysm formation
B. Dialysis adequacy
C. Vascular access thrombosis rates
D. Infection risk compared to rope-ladder technique
➡️ Answer: A. Cannulation-related aneurysm formation
17. Which practice is essential to prevent infections in buttonhole cannulation?
A. Strict aseptic technique and scab removal before needle insertion
B. Use of sharp needles every session
C. Changing needle insertion sites daily
D. Avoiding antiseptics
➡️ Answer: A. Strict aseptic technique and scab removal before needle insertion
18. What was a driving factor for developing the buttonhole technique in the 1970s?
A. High patient discomfort and damage from repeated needle insertions
B. High cost of dialysis membranes
C. Lack of trained staff
D. Need for faster dialysis sessions
➡️ Answer: A. High patient discomfort and damage from repeated needle insertions
19. Which of the following outcomes has been observed with buttonhole cannulation?
A. Reduced pain scores during cannulation
B. Increased incidence of stenosis
C. Decreased fistula blood flow
D. Increased hematoma formation
➡️ Answer: A. Reduced pain scores during cannulation
20. What is a common method used to form the buttonhole track?
A. Repeated cannulation with sharp needles at the same site and angle to create a tunnel
B. Surgical creation of a tunnel
C. Use of blunt needles from the first session
D. Random cannulation sites over the fistula
➡️ Answer: A. Repeated cannulation with sharp
21. In which patient group has the buttonhole technique shown the greatest benefit?
A. Patients with difficult or painful cannulation sites
B. Patients with newly created fistulas
C. Patients on peritoneal dialysis
D. Patients with central venous catheters
➡️ Answer: A. Patients with difficult or painful cannulation sites
22. What is a key difference in needle use between buttonhole and rope-ladder techniques after track formation?
A. Buttonhole uses blunt needles, rope-ladder uses sharp needles
B. Both use blunt needles
C. Buttonhole uses larger bore needles
D. Rope-ladder uses blunt needles only
➡️ Answer: A. Buttonhole uses blunt needles, rope-ladder uses sharp needles
23. How does the buttonhole technique potentially reduce aneurysm formation?
A. By repeatedly cannulating the exact same spot, preventing repeated trauma at multiple sites
B. By increasing blood flow velocity
C. By using smaller needles
D. By avoiding cannulation altogether
➡️ Answer: A. By repeatedly cannulating the exact same spot, preventing repeated trauma at multiple sites
24. Which of the following is a significant infection risk factor in buttonhole cannulation?
A. Improper scab removal before needle insertion
B. Use of blunt needles only
C. Rotating cannulation sites daily
D. Use of antiseptic solution
➡️ Answer: A. Improper scab removal before needle insertion
25. Buttonhole cannulation was inspired by which principle or concept?
A. Creating a tunnel track similar to a pierced ear or catheter tract
B. Random site rotation
C. Surgical graft placement
D. Use of only large bore needles
➡️ Answer: A. Creating a tunnel track similar to a pierced ear or catheter tract
26. What is a commonly reported patient satisfaction benefit of buttonhole cannulation?
A. Decreased pain and anxiety related to needle insertion
B. Increased dialysis time
C. Reduced blood flow rates
D. Need for fewer dialysis sessions
➡️ Answer: A. Decreased pain and anxiety related to needle insertion
27. What infection control practice is crucial specifically for buttonhole tracks?
A. Gentle scab removal with sterile technique before needle insertion
B. Use of non-sterile gloves
C. Avoiding cleaning of the site
D. Using sharp needles for all cannulations
➡️ Answer: A. Gentle scab removal with sterile technique before needle insertion
28. When buttonhole tracks become infected, what is a common treatment approach?
A. Antibiotics and sometimes surgical excision of the track
B. Increased dialysis frequency
C. Use of larger needles
D. Changing to peritoneal dialysis
➡️ Answer: A. Antibiotics and sometimes surgical excision of the track
29. Which statement best describes the impact of the buttonhole technique on vascular access longevity?
A. It may reduce trauma and prolong fistula lifespan but requires careful infection control
B. It shortens fistula lifespan
C. It increases thrombosis rates
D. It has no impact on fistula longevity
➡️ Answer: A. It may reduce trauma and prolong fistula lifespan but requires careful infection control
30. Which of the following is a contraindication to starting the buttonhole technique?
A. Presence of fistula infection or abscess
B. Mature fistula with adequate blood flow
C. Painful cannulation with conventional techniques
D. Patient preference for buttonhole
➡️ Answer: A. Presence of fistula infection or abscess
31. What type of needle is recommended for use once the buttonhole track is mature?
A. Blunt needle
B. Sharp needle
C. Large bore needle only
D. Intravenous catheter
➡️ Answer: A. Blunt needle
32. How often should the buttonhole track be cannulated in order to maintain its integrity?
A. Every dialysis session
B. Every other session
C. Weekly
D. Monthly
➡️ Answer: A. Every dialysis session
33. Which of the following complications has been reported more frequently with buttonhole cannulation compared to rope-ladder?
A. Staphylococcus aureus infections
B. Vascular stenosis
C. Aneurysm formation
D. Lower blood flow rates
➡️ Answer: A. Staphylococcus aureus infections
34. What is the recommended method to reduce infection risk during buttonhole cannulation?
A. Careful removal of scabs with sterile instruments and antiseptic skin preparation
B. Use of non-sterile gloves to avoid contamination
C. Skipping antiseptic preparation to avoid skin irritation
D. Rotating cannulation sites every session
➡️ Answer: A. Careful removal of scabs with sterile instruments and antiseptic skin preparation
35. Which of the following is a potential benefit of buttonhole cannulation?
A. Reduced aneurysm formation
B. Increased bleeding complications
C. Higher infection rates
D. Decreased dialysis adequacy
➡️ Answer: A. Reduced aneurysm formation
36. What is the typical duration required to form a mature buttonhole tunnel?
A. 6-10 sessions of repeated cannulation at the same site
B. 1 session
C. 3-4 weeks
D. 3-6 months
➡️ Answer: A. 6-10 sessions of repeated cannulation at the same site
37. Buttonhole technique is most suitable for patients with:
A. Established, mature arteriovenous fistulas with challenging cannulation
B. Newly created fistulas
C. Central venous catheters
D. Peritoneal dialysis catheters
➡️ Answer: A. Established, mature arteriovenous fistulas with challenging cannulation
38. What is the main reason for infection risk in buttonhole technique?
A. Scab formation over the buttonhole tract harboring bacteria
B. Use of blunt needles
C. Repeated rotation of needle sites
D. Use of sterile technique
➡️ Answer: A. Scab formation over the buttonhole tract harboring bacteria
39. The buttonhole technique reduces which patient discomfort compared to the rope-ladder technique?
A. Needle insertion pain
B. Dizziness
C. Hypotension during dialysis
D. Muscle cramps
➡️ Answer: A. Needle insertion pain
40. Which of the following is an important training aspect for staff performing buttonhole cannulation?
A. Consistent technique in needle angle and insertion site, plus strict aseptic technique
B. Rotating insertion sites each session
C. Avoiding antiseptics to preserve skin integrity
D. Using sharp needles only
➡️ Answer: A. Consistent technique in needle angle and insertion site, plus strict aseptic technique
41. What type of vascular access is the buttonhole technique primarily used for?
A. Arteriovenous fistula (AVF)
B. Central venous catheter (CVC)
C. Peritoneal dialysis catheter
D. Arteriovenous graft (AVG)
➡️ Answer: A. Arteriovenous fistula (AVF)
42. Which of the following is a recognized advantage of the buttonhole technique?
A. Less needle-related pain and easier cannulation
B. Decreased risk of vascular access stenosis
C. Reduced need for anticoagulation
D. Shorter dialysis treatment times
➡️ Answer: A. Less needle-related pain and easier cannulation
43. Which complication remains a concern and requires careful monitoring in patients using the buttonhole technique?
A. Infection, especially Staphylococcus aureus bacteremia
B. Dialyzer membrane failure
C. Peritoneal leakage
D. Electrolyte imbalance
➡️ Answer: A. Infection, especially Staphylococcus aureus bacteremia
44. How can the risk of infection in buttonhole cannulation be minimized?
A. Removing scabs gently with sterile tools and using antiseptic skin preparation
B. Skipping scab removal to avoid trauma
C. Using sharp needles every session
D. Avoiding skin cleaning to preserve natural flora
➡️ Answer: A. Removing scabs gently with sterile tools and using antiseptic skin preparation
45. Which clinical scenario is least appropriate for starting buttonhole cannulation?
A. A newly created AV fistula less than 6 weeks old
B. A mature AV fistula with painful cannulation
C. A patient with needle phobia
D. A patient with limited cannulation sites
➡️ Answer: A. A newly created AV fistula less than 6 weeks old
46. The buttonhole technique is sometimes compared with which other cannulation method?
A. Rope-ladder technique
B. Central venous catheterization
C. Peritoneal dialysis
D. Arteriovenous graft cannulation
➡️ Answer: A. Rope-ladder technique
47. Buttonhole technique reduces trauma to the fistula by:
A. Using the same needle track repeatedly, minimizing vessel wall damage
B. Changing needle insertion sites daily
C. Using larger bore needles
D. Avoiding needle use altogether
➡️ Answer: A. Using the same needle track repeatedly, minimizing vessel wall damage
48. What is a common patient complaint that buttonhole cannulation aims to address?
A. Pain during needle insertion
B. Dialysis-related hypotension
C. Electrolyte imbalances
D. Fatigue post dialysis
➡️ Answer: A. Pain during needle insertion
49. Which training element is critical for staff performing buttonhole cannulation?
A. Strict aseptic technique and consistent needle placement
B. Use of non-sterile gloves to improve dexterity
C. Rotating sites every session
D. Avoiding antiseptics to reduce skin irritation
➡️ Answer: A. Strict aseptic technique and consistent needle placement
50. Which statement about the buttonhole technique is TRUE?
A. It may increase infection risk if strict hygiene is not maintained
B. It completely eliminates risk of infection
C. It is suitable for all dialysis patients immediately after fistula creation
D. It requires changing the cannulation site every dialysis session
➡️ Answer: A. It may increase infection risk if strict hygiene is not maintained
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