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Cannulation then AP24534 in vitro occurred with blunt 15G needles along the site of previous tracks. If the needle did not pass easily into the fistula, it was removed and a further attempt at cannulation was performed. Rope-ladder technique Patients arriving for haemodialysis underwent standard hand washing with soap and a sterile dressing trolley was prepared using a combination of sodium dichloroisocyanurate disinfectant tablets and a surfactant-based detergent dissolved in water. The entire fistula was then cleaned with alcohol-based chlorhexidine wipes. Cannulation then occurred at rotating areas along the length of the fistula with 15G sharp fistula needles. Baseline characteristics between the two groups were compared using univariate analysis. Infection rates between the groups were compared using the Wilcoxon rank sum test, and Kaplan�CMeier survival curves were produced to highlight significant differences. Multivariate analyses using the Cox proportional hazards model were used to adjust for potential confounding factors including age, sex, time on haemodialysis and presence of diabetes mellitus. Results One hundred and twenty-seven patients were included in the study, 53 patients used the rope-ladder technique while 74 used the buttonhole technique (Table 1). Table 1. Baseline patient characteristics Patients in the buttonhole group were more UNC2881 likely to be younger, and were more likely to be male. There were no differences in home haemodialysis uptake between the sexes. Patients in the buttonhole group had an average longer dialysis duration per session. There were similar numbers of patients with diabetes mellitus in both the groups. There were nine episodes of AVF infection in the buttonhole group, which equates to 0.073 events per 1000 AVF days. There were no AVF infections in the rope-ladder group. This difference was statistically significant, P = 0.023 (Figure 1). Fig. 1. Survival curve showing time to AVF infection in both groups P = 0.023. Of the patients who developed infectious events, six were aged STI571 supplier this was isolated in eight patients. The other patient developed Staphylococcus epidermidis infection. There were no MRSA-related infections. Four of the eight patients who developed MSSA-associated fistula infections also developed infective endocarditis (Table 2). This corresponds to a rate of 0.02 events of infective endocarditis per 1000 AVF days. Table 2. Characteristics of patients who developed AVF-associated infection One patient with endocarditis died. One patient developed MSSA cervical discitis. This patient withdrew from haemodialysis and died. Patients who underwent in-centre haemodialysis received standard hygiene procedures prior to treatment. Five of the nine patients who developed AVF infections were undergoing home haemodialysis. This equates to a rate of 1.45 events per 1000 AVF days.