✅ MCQs: Buttonhole vs Conventional Cannulation – Quality Outcomes
1. What is a key advantage of buttonhole cannulation over conventional cannulation?
A. Higher risk of aneurysm formation
B. Reduced pain during needle insertion
C. Increased need for needle repositioning
D. Higher incidence of hematoma
➡️ Answer: B. Reduced pain during needle insertion
2. Buttonhole cannulation involves:
A. Using a new puncture site for every dialysis session
B. Creating a tract by repeatedly cannulating the exact same spot and angle
C. Random needle insertion in the fistula
D. Only using metal needles
➡️ Answer: B. Creating a tract by repeatedly cannulating the exact same spot and angle
3. Which complication is reported more commonly with buttonhole cannulation compared to conventional?
A. Lower infection rates
B. Increased infection risk (tunnel infections, bacteremia)
C. Fewer aneurysms
D. No complications reported
➡️ Answer: B. Increased infection risk (tunnel infections, bacteremia)
4. Conventional cannulation is sometimes preferred because:
A. It has a consistent lower infection rate
B. It causes less pain
C. It prevents hematoma formation better than buttonhole
D. It is easier for patients to self-cannulate
➡️ Answer: A. It has a consistent lower infection rate
5. Buttonhole cannulation is best suited for:
A. Patients with newly created AV fistulas
B. Patients with mature, well-developed AV fistulas
C. Patients on peritoneal dialysis
D. Patients with central venous catheters
➡️ Answer: B. Patients with mature, well-developed AV fistulas
6. Which of the following is a reported benefit of buttonhole cannulation?
A. Decreased need for needle repositioning and infiltration
B. Increased needle-site pain
C. Higher rate of clotting
D. Increased vascular trauma
➡️ Answer: A. Decreased need for needle repositioning and infiltration
7. The “buttonhole tract” is created by:
A. Using blunt needles after the initial tunnel is formed
B. Switching sites each session
C. Using sharp needles every session
D. Avoiding fistula cannulation altogether
➡️ Answer: A. Using blunt needles after the initial tunnel is formed
8. Which practice reduces the infection risk associated with buttonhole cannulation?
A. Avoiding disinfectant use
B. Proper aseptic technique and scab removal before cannulation
C. Using larger gauge needles
D. Cannulating at multiple sites each session
➡️ Answer: B. Proper aseptic technique and scab removal before cannulation
9. Compared to conventional cannulation, buttonhole technique generally:
A. Increases needle-related complications
B. Decreases cannulation pain and bruising
C. Is associated with more aneurysm formation
D. Requires longer dialysis sessions
➡️ Answer: B. Decreases cannulation pain and bruising
10. Which of the following is NOT a typical outcome difference between buttonhole and conventional cannulation?
A. Buttonhole reduces cannulation pain
B. Conventional cannulation has fewer infections
C. Buttonhole increases aneurysm formation
D. Conventional cannulation requires creation of new puncture sites
➡️ Answer: C. Buttonhole increases aneurysm formation
(No clear evidence buttonhole increases aneurysm formation.)
11. Which needle type is recommended for use after the buttonhole tract is established?
A. Sharp needle
B. Blunt needle
C. Butterfly needle
D. Large bore catheter
➡️ Answer: B. Blunt needle
12. What is a common early complication during the learning phase of buttonhole cannulation?
A. Immediate infection
B. Difficulty locating the tract leading to infiltration
C. Permanent fistula damage
D. Hyperkalemia
➡️ Answer: B. Difficulty locating the tract leading to infiltration
13. Buttonhole cannulation has been shown to:
A. Reduce hematoma formation compared to conventional cannulation
B. Increase clot formation risk in all patients
C. Have no effect on patient comfort
D. Be less effective in reducing cannulation pain
➡️ Answer: A. Reduce hematoma formation compared to conventional cannulation
14. A major concern limiting wider adoption of buttonhole cannulation is:
A. Higher cost of blunt needles
B. Increased risk of Staphylococcus aureus infections
C. Requirement for frequent needle repositioning
D. Increased incidence of bleeding
➡️ Answer: B. Increased risk of Staphylococcus aureus infections
15. Proper training for buttonhole cannulation should emphasize:
A. Rotation of puncture sites every session
B. Consistent use of the same needle size and angle
C. Using sharp needles at every session
D. Avoiding scab removal to prevent trauma
➡️ Answer: B. Consistent use of the same needle size and angle
16. Compared to conventional technique, buttonhole cannulation often results in:
A. More frequent aneurysm formation
B. Reduced overall vascular trauma
C. Higher rates of catheter-related infections
D. Increased dialysis session time
➡️ Answer: B. Reduced overall vascular trauma
17. Which of the following is NOT recommended in buttonhole cannulation care?
A. Disinfecting the site before cannulation
B. Removing scabs before needle insertion
C. Using a new puncture site every session
D. Using blunt needles after tract formation
➡️ Answer: C. Using a new puncture site every session
18. In terms of patient preference, buttonhole cannulation is generally:
A. Less preferred due to pain
B. More preferred due to less pain and easier self-cannulation
C. Equally preferred as conventional
D. Not preferred due to increased bleeding
➡️ Answer: B. More preferred due to less pain and easier self-cannulation
19. Which patient group may particularly benefit from buttonhole cannulation?
A. Patients with new AV fistulas (<3 months)
B. Patients with difficult veins or needle phobia
C. Patients on peritoneal dialysis
D. Patients with central venous catheters
➡️ Answer: B. Patie
20. To minimize infection risk in buttonhole cannulation, it is important to:
A. Use sterile technique and antibiotic ointment at the site
B. Skip antiseptic cleaning to avoid irritation
C. Use larger gauge needles every session
D. Avoid scab removal to maintain a natural barrier
21. What is the typical time frame to fully establish a buttonhole tract?
A. 1-3 dialysis sessions
B. 5-10 dialysis sessions
C. 10-15 dialysis sessions
D. 20-30 dialysis sessions
➡️ Answer: C. 10-15 dialysis sessions
22. Which of the following is a major reason some centers avoid buttonhole cannulation?
A. Increased bleeding complications
B. Increased time required for cannulation
C. Higher rates of bacteremia compared to conventional cannulation
D. Lack of patient acceptance
➡️ Answer: C. Higher rates of bacteremia compared to conventional cannulation
23. The first needle used to create the buttonhole tract is:
A. A blunt needle
B. A sharp needle
C. A catheter
D. A large-bore dialysis needle
➡️ Answer: B. A sharp needle
24. Buttonhole cannulation is associated with:
A. Greater preservation of vascular access sites
B. Greater damage to the vessel wall
C. Increased pain during needle insertion
D. Frequent need to change cannulation sites
➡️ Answer: A. Greater preservation of vascular access sites
25. Which of the following infections is most commonly associated with buttonhole cannulation?
A. Escherichia coli
B. Staphylococcus aureus
C. Pseudomonas aeruginosa
D. Candida albicans
➡️ Answer: B. Staphylococcus aureus
26. Compared to conventional technique, buttonhole cannulation can:
A. Increase the incidence of infiltration and hematoma
B. Reduce needle-related anxiety in patients
C. Increase the need for systemic antibiotics
D. Increase the risk of AV fistula thrombosis
➡️ Answer: B. Reduce needle-related anxiety in patients
27. Which of the following is a common sign of buttonhole infection?
A. Clear fluid drainage
B. Persistent scab at the site with redness and tenderness
C. Decreased fistula thrill
D. Increased blood flow rates
➡️ Answer: B. Persistent scab at the site with redness and tenderness
28. When converting from conventional to buttonhole cannulation, what is essential?
A. Immediate use of blunt needles
B. Creation of the tract by using sharp needles at the same site consistently
C. Use of larger gauge needles initially
D. Changing cannulation site weekly
➡️ Answer: B. Creation of the tract by using sharp needles at the same site consistently
29. Which one is true about self-cannulation in buttonhole technique?
A. Not recommended due to high risk of infection
B. Often easier and less painful than conventional cannulation
C. Requires larger needles
D. Causes more vascular trauma
➡️ Answer: B. Often easier and less painful than conventional cannulation
30. Which practice improves outcomes of buttonhole cannulation?
A. Avoiding scab removal before cannulation
B. Using a new needle insertion site each session
C. Daily site inspection and strict hygiene
D. Using sharp needles after tract formation
➡️ Answer: C. Daily site inspection and strict hygiene
31. The formation of a fibrous tunnel in buttonhole cannulation helps to:
A. Prevent hematoma formation
B. Reduce repeated vessel wall trauma
C. Increase bleeding risk
D. Promote infection spread
➡️ Answer: B. Reduce repeated vessel wall trauma
32. Which of the following is true regarding pain perception in buttonhole cannulation?
A. It causes more pain than conventional cannulation
B. It is typically less painful due to the established tract
C. Pain levels are the same in both techniques
D. Pain is unpredictable and varies widely without pattern
➡️ Answer: B. It is typically less painful due to the established tract
33. A potential disadvantage of buttonhole cannulation is:
A. Increased use of anticoagulants
B. Formation of aneurysms at the puncture site
C. Higher risk of local and systemic infection
D. Increased need for surgical revision
➡️ Answer: C. Higher risk of local and systemic infection
34. The “scab” formed at the buttonhole site must be:
A. Left intact during cannulation
B. Removed carefully before needle insertion
C. Ignored if no redness is present
D. Removed only if patient complains of pain
➡️ Answer: B. Removed carefully before needle insertion
35. What role does patient education play in buttonhole cannulation success?
A. Minimal role, mainly staff responsibility
B. Crucial for infection prevention and proper technique
C. Only important if the patient self-cannulates
D. No impact on complication rates
➡️ Answer: B. Crucial for infection prevention and proper technique
36. Compared to conventional cannulation, buttonhole technique generally:
A. Requires larger needles
B. Increases frequency of needle-site bruising
C. Allows easier self-cannulation by patients
D. Increases need for new access creation
➡️ Answer: C. Allows easier self-cannulation by patients
37. Which of the following is a recommended best practice to reduce infections in buttonhole cannulation?
A. Using non-sterile gloves
B. Avoiding antibiotic ointment at the site
C. Applying strict aseptic technique including chlorhexidine cleaning
D. Skipping hand hygiene if wearing gloves
➡️ Answer: C. Applying strict aseptic technique including chlorhexidine cleaning
38. Which statement is true about the impact of buttonhole cannulation on fistula longevity?
A. It definitively shortens fistula lifespan
B. Evidence is mixed but may preserve fistula by reducing trauma
C. It leads to immediate fistula failure
D. It has no impact on fistula function
➡️ Answer: B. Evidence is mixed but may preserve fistula by reducing trauma
39. In which scenario is conventional cannulation preferred over buttonhole?
A. Mature fistulas with scar tissue
B. New fistulas still maturing
C. Patients with needle anxiety
D. Patients practicing self-cannulation
➡️ Answer: B. New fistulas still maturing
40. One strategy to reduce infection risk in buttonhole cannulation is to:
A. Change the needle insertion site daily
B. Use blunt needles from the start
C. Regularly monitor for signs of infection and treat promptly
D. Avoid scab removal entirely
➡️ Answer: C. Regularly monitor for signs of infection and treat promptly
41. Which of the following statements is TRUE regarding buttonhole cannulation infection rates?
A. They are consistently lower than conventional cannulation infections
B. They can be higher if aseptic technique is not strictly followed
C. Infection risk is negligible regardless of technique
D. Buttonhole cannulation eliminates infection risk completely
➡️ Answer: B. They can be higher if aseptic technique is not strictly followed
42. What is the recommended needle gauge for buttonhole cannulation after the tract is established?
A. 14-16 gauge blunt needle
B. 20 gauge sharp needle
C. 18 gauge sharp needle
D. 12 gauge catheter needle
➡️ Answer: A. 14-16 gauge blunt needle
43. Which of the following is NOT a benefit of buttonhole cannulation?
A. Reduced pain during needle insertion
B. Lower rate of aneurysm formation
C. Reduced needle infiltration incidents
D. Increased risk of thrombosis
➡️ Answer: D. Increased risk of thrombosis
44. How does buttonhole cannulation affect the need for needle repositioning during dialysis?
A. Increases the need due to inconsistent tract formation
B. Decreases the need because the tract guides needle placement
C. Has no impact on needle repositioning frequency
D. Requires repositioning every session to avoid infection
➡️ Answer: B. Decreases the need because the tract guides needle placement
45. Which of the following is a recognized complication specific to buttonhole cannulation?
A. Central vein stenosis
B. Tunnel tract infection
C. Hyperkalemia
D. Peritonitis
➡️ Answer: B. Tunnel tract infection
46. What is a key patient education point for those performing self-cannulation using the buttonhole technique?
A. Use the same needle size and angle each time
B. Change the puncture site daily
C. Avoid cleaning the site to prevent irritation
D. Remove the scab only if it causes pain
➡️ Answer: A. Use the same needle size and angle each time
47. Which antiseptic is most commonly recommended for cleaning the buttonhole site before cannulation?
A. Alcohol only
B. Povidone-iodine
C. Chlorhexidine
D. Hydrogen peroxide
➡️ Answer: C. Chlorhexidine
48. Buttonhole cannulation is least appropriate in which of the following situations?
A. Patients with needle phobia
B. Patients with immature fistulas
C. Patients who self-cannulate
D. Patients with mature fistulas
➡️ Answer: B. Patients with immature fistulas
49. Which of the following best describes the “buttonhole” tract?
A. A new puncture site each dialysis
B. A scarred tunnel created by repeated cannulations at the same site and angle
C. A needle track through muscle tissue
D. A fistula complication requiring surgery
➡️ Answer: B. A scarred tunnel created by repeated cannulations at the same site and angle
50. When monitoring a patient with buttonhole cannulation, what early sign might indicate infection?
A. Decreased blood pressure
B. Persistent redness and tenderness at the site
C. Increased dialysis adequacy (Kt/V)
D. Absence of fistula bruit
➡️ Answer: B. Persistent redness and tenderness at the site
51. Which of the following best describes the effect of buttonhole cannulation on hematoma formation?
A. Buttonhole increases hematoma formation
B. Buttonhole reduces hematoma formation compared to conventional
C. No difference in hematoma formation
D. Conventional cannulation eliminates hematoma
➡️ Answer: B. Buttonhole reduces hematoma formation compared to conventional
52. What is the main reason for the higher infection risk in buttonhole cannulation?
A. Frequent needle site changes
B. Repeated cannulation of the same site creating a tunnel susceptible to bacteria
C. Use of blunt needles
D. Larger needle gauge
➡️ Answer: B. Repeated cannulation of the same site creating a tunnel susceptible to bacteria
53. How can infection risk be minimized in buttonhole cannulation?
A. Avoiding scab removal before cannulation
B. Using sterile technique and careful scab removal prior to needle insertion
C. Using sharp needles every session
D. Ignoring redness unless fever develops
➡️ Answer: B. Using sterile technique and careful scab removal prior to needle insertion
54. In which scenario might buttonhole cannulation NOT be recommended?
A. Long-term stable AV fistulas
B. Newly created AV fistulas (<3 months)
C. Patients with needle phobia
D. Patients performing self-cannulation
➡️ Answer: B. Newly created AV fistulas (<3 months)
55. Which is a common reason patients prefer buttonhole cannulation?
A. More painful insertion
B. Reduced pain and anxiety during needle insertion
C. Increased bruising
D. Longer cannulation times
➡️ Answer: B. Reduced pain and anxiety during needle insertion
56. What type of needle is used after the buttonhole tract is formed?
A. Sharp needle only
B. Blunt needle
C. Butterfly needle
D. Large bore catheter
➡️ Answer: B. Blunt needle
57. Which of the following complications is shared by both buttonhole and conventional cannulation?
A. Tunnel tract infections
B. Hematoma and infiltration
C. Higher risk of systemic bacteremia unique to buttonhole
D. None of the above
➡️ Answer: B. Hematoma and infiltration
58. Which clinical practice improves buttonhole cannulation success?
A. Rotating needle sites every session
B. Consistent needle angle and site with same needle size
C. Using large gauge sharp needles after tract formation
D. Skipping antiseptic cleaning to preserve skin integrity
➡️ Answer: B. Consistent needle angle and site with same needle size
59. Why is patient education critical in buttonhole cannulation?
A. To ensure adherence to infection prevention protocols
B. To train patients on self-cannulation techniques
C. To identify early signs of infection
D. All of the above
➡️ Answer: D. All of the above
60. Which of the following statements is TRUE?
A. Buttonhole cannulation eliminates all vascular access complications
B. Conventional cannulation is always safer than buttonhole
C. Buttonhole cannulation can reduce vascular trauma but may increase infection risk if poorly managed
D. Infection risk is the same in both methods regardless of care
➡️ Answer: C. Buttonhole cannulation can reduce vascular trauma but may increase infection risk if poorly managed
61. Which of the following best describes the typical needle insertion technique in conventional cannulation?
A. Repeatedly using the exact same site and angle
B. Rotating needle insertion sites for each session
C. Only using blunt needles
D. Only self-cannulation is allowed
➡️ Answer: B. Rotating needle insertion sites for each session
62. What is a major clinical sign of fistula infection in buttonhole cannulation?
A. Fistula bruit increase
B. Persistent redness, swelling, and pain at the site
C. Increased thrill strength
D. Decreased dialysis adequacy
➡️ Answer: B. Persistent redness, swelling, and pain at the site
63. Which best describes the impact of buttonhole cannulation on patient self-care?
A. Makes self-cannulation more difficult
B. Enables easier and less painful self-cannulation
C. Does not affect self-care ability
D. Is contraindicated for patients who self-cannulate
➡️ Answer: B. Enables easier and less painful self-cannulation
64. A patient using buttonhole cannulation reports increasing pain and swelling at the site. What should be the immediate action?
A. Continue with cannulation and monitor
B. Stop using the buttonhole site and assess for infection
C. Increase needle gauge
D. Ignore if no fever present
➡️ Answer: B. Stop using the buttonhole site and assess for infection
65. What is the role of scab removal in buttonhole cannulation?
A. It is unnecessary and should be avoided
B. It is essential to prevent needle insertion through contaminated tissue
C. It should be done only if there is visible pus
D. It should be done after needle insertion
➡️ Answer: B. It is essential to prevent needle insertion through contaminated tissue
66. Which factor contributes most to reducing infection risk in buttonhole cannulation?
A. Use of larger needles
B. Skipping hand hygiene
C. Strict aseptic technique including site cleaning and scab removal
D. Repeated use of sharp needles
➡️ Answer: C. Strict aseptic technique including site cleaning and scab removal
67. Which complication is more associated with conventional cannulation than buttonhole?
A. Higher risk of aneurysm formation due to repeated puncture sites
B. Higher infection rates
C. Higher risk of tunnel tract infection
D. Less bruising
➡️ Answer: A. Higher risk of aneurysm formation due to repeated puncture sites
68. Which statement regarding blunt needles in buttonhole cannulation is TRUE?
A. They are only used during the initial tract formation
B. They reduce trauma and pain during needle insertion after tract formation
C. They increase infection risk
D. They are never used in buttonhole cannulation
➡️ Answer: B. They reduce trauma and pain during needle insertion after tract formation
69. The formation of the buttonhole tract requires:
A. Random needle placements at different angles
B. Repeated cannulation at the same site with the same angle and depth
C. Using blunt needles from the start
D. Frequent site rotation
➡️ Answer: B. Repeated cannulation at the same site with the same angle and depth
70. What is a critical difference in needle management between buttonhole and conventional cannulation?
A. Buttonhole uses sharp needles each session
B. Buttonhole uses blunt needles after the tract is formed; conventional uses sharp needles every time
C. Conventional uses blunt needles after tract formation
D. Both use blunt needles every session
➡️ Answer: B. Buttonhole uses blunt needles after the tract is formed; conventional uses sharp needles every time
71. Which statement best describes the rationale for rotating needle sites in conventional cannulation?
A. To reduce the risk of aneurysm and vessel wall damage
B. To create a permanent tunnel tract
C. To reduce infection risk associated with repeated punctures
D. Both A and C
➡️ Answer: D. Both A and C
72. Which of the following is a reported benefit of buttonhole cannulation regarding vascular access survival?
A. Definitively prolongs fistula life in all patients
B. May reduce vascular trauma and prolong access usability
C. Has no impact on access longevity
D. Always leads to early fistula failure
➡️ Answer: B. May reduce vascular trauma and prolong access usability
73. In buttonhole cannulation, what is the recommended management if a scab at the site is difficult to remove?
A. Forcefully remove the scab immediately before cannulation
B. Soften the scab with antiseptic solution and remove gently prior to cannulation
C. Skip removal and puncture through it
D. Delay dialysis session until scab falls off naturally
➡️ Answer: B. Soften the scab with antiseptic solution and remove gently prior to cannulation
74. Which microorganism is most commonly implicated in buttonhole cannulation-related infections?
A. Streptococcus pyogenes
B. Staphylococcus aureus
C. Klebsiella pneumoniae
D. Candida species
➡️ Answer: B. Staphylococcus aureus
75. Which is TRUE regarding the use of antibiotic ointments in buttonhole care?
A. They are never recommended
B. They may reduce infection risk when applied at the cannulation site after cleaning
C. They increase scab formation and should be avoided
D. They should replace antiseptic cleaning
➡️ Answer: B. They may reduce infection risk when applied at the cannulation site after cleaning
76. Which is a disadvantage of conventional cannulation compared to buttonhole?
A. Higher infection risk
B. More pain and discomfort during needle insertion
C. Requires less training
D. Lower incidence of hematoma
➡️ Answer: B. More pain and discomfort during needle insertion
77. What is the main challenge when first transitioning a patient from conventional to buttonhole cannulation?
A. Creating a consistent tract by cannulating the same site and angle repeatedly
B. Finding new sites to cannulate each session
C. Switching from blunt to sharp needles too early
D. Increased infection risk due to site rotation
➡️ Answer: A. Creating a consistent tract by cannulating the same site and angle repeatedly
78. Which is NOT a recommended practice for buttonhole cannulation site care?
A. Daily inspection of the site
B. Careful removal of scab before cannulation
C. Using the same needle angle and depth every session
D. Using the same needle insertion site only during the first session
➡️ Answer: D. Using the same needle insertion site only during the first session
79. Why might some clinicians prefer conventional cannulation over buttonhole?
A. Lower pain levels reported by patients
B. Lower infection risk, especially in centers with limited infection control resources
C. Easier for patients to self-cannulate
D. Less vascular trauma
➡️ Answer: B. Lower infection risk, especially in centers with limited infection control resources
80. Which statement about hematoma formation is correct?
A. Buttonhole cannulation typically causes more hematomas
B. Conventional cannulation is associated with more frequent hematoma formation
C. Both techniques have the same hematoma risk
D. Hematomas are rare with both techniques
➡️ Answer: B. Conventional cannulation is associated with more frequent hematoma formation
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