الفهرس 
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Abstract
Hemodialysis patients with CKD should have functional access to their blood. There are three approaches to establishing access: arteriovenous graft, AVF, and CVC. Because it provides the best patency and lowest problems, the AVF is the most popular and preferred access. But the Dialysis Outcomes and Practice Patterns Study (DOPPS) found that 37% of all new AVFs experience complications during the first six months, including stenosis, local and systemic infections, and thrombosis. (Carroll et al., 2020).
The buttonhole technique is a cannulation technique in which the AVF is always cannulated at the same location, at the same angle, and with the same depth of penetration. A similar location will be used to make a scar tissue tunnel track. Until the track tunnel has been cannulated, the technique should be performed by the same cannulator(Carroll et al., 2020).
Cannulation of a buttonhole It over the life of an AVF, more restlessness and infection, decreases missed cannulations, decrease the risk of infiltrations, encourages self-cannulation, lowers the hospitalizations for AVF complications, lowers the chance of suffering a needle injury, and lesser the chance of developing a hematoma. (Oven & Scarlett, 2020).
The present study aimed to evaluate the effect of using nursing guidelines for the Buttonhole cannulation technique on reducing its complications among hemodialysis patients. The patients who will use the buttonhole cannulation technique will have fewer complications.
Methods: A quasi-experimental research approach was used.
A purposive sample contain 60 patients undergoing HD Study sample was divided equally and was selected according to certain inclusive and exclusive criteria classified into S& CGs (30 SG & 30 CG) and agreed to participate in the study.
Four Tools
Tool 1: Interviewing Questionnaire
This tool that developed by the investigator to collect personal data based on relevant literature. It is divided into two sections:
1st part: Demographic characteristic as code, age, education level, marital status, occupation, and place of residence.
2nd part : Patient’s Medical Profile: It involved having a chronic disease, kind of chronic disease, site of first vascular access, type of vascular access on starting hemodialysis, and vital signs.
Tool II:Pain Assessment Scale developed by Galer and Gammaitoni (2003). It was used to assess the patient level of pain during implementing and buttonhole cannulation techniques. It included Numeric Pain Intensity Scale.
Tool III: Observational Checklist
Prepared by the researcher following a thorough literature study to evaluate the signs and symptoms of problems related to arteriovenous cannulation It has two components, listed as follows: 1st part: Infection symptoms include redness, widespread swelling, heat, and fistula exudate. 2nd part: Specific hematoma manifestations like the start of a hematoma, color changes, skin bruising, and localized swelling.
Tool IV: The assessment sheet had 2 parts: 1st : Successful laboratory analysis of creatinine, s. urea, potassium, phosphorus, salt, calcium, and blood cultures to determine kidney function. 2nd : Specific cannulation and dialysis problems, including hypertension and heat
The main findings of the present study:
As regards the difference between the frequency distribution of sharing groups regarding their pain levels when they created and removal of HD cannulation When established with buttonhole cannulation following study application guidelines, there were statistically significant differences in pain levels between the two groups during the first week of hemodialysis, but there were highly statistically significant differences in pain levels between the two groups when established and removed buttonhole cannulation during the 4th week of hemodialysis.
Regarding the difference between the frequency distribution of sharing groups in relation to presence of infections, in terms of infection manifestations, there were no statistically significant differences among the studied groups during the first week of HD sessions, but there was a highly statistically significant difference between the two groups during the fourth week of HD sessions following the application of study guidelines, with a P value of 0.01.
As regards the difference between sharing group in relation the occurrence of specific complications HD ” hematoma ” between them during sessions of HD ”Hematoma was present in 13.3% of the study group and 36.7% of the control group at the first week of HD following the application of the study guidelines, and in 3.3% and 86.7% of both groups at the fourth week of HD following the administration of the study guidelines, respectively.
As regards the comparison between participating groups regarding their BP & temperature measurements interpretation, at the first and fourth weeks of HD session’s post-application of study guidelines, there was no statistically significant difference in the interpretation of BP and temperature measurements between the S &CG.
Regarding the relation between age and presence of chronic disease of participated groups and the occurrence of infection, hematoma, pain level intensity, hyperthermia, and hypertension at the 4th week of HD sessions there was no statistically significant relation between participated groups’ age and their chronic disease with the occurrence of infection, hematoma, pain levels when buttonhole cannulation was removed, hypertension, and hyperthermia. Except, with a P-value ≤ 0.05. There was only a statistically significant relationship between the presence of chronic disease and the feeling of pain intensity during establishing buttonhole cannulation in the 4th week of HD sessions post application of study guidelines among the participating groups.