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Competing Interests: V.D. Niyyar reports receiving honoraria from Albert–Einstein Montefiore and KidneyCon (for being invited faculty); from the American Society of Diagnostic and Interventional Nephrology (ASDIN), American Society of Nephrology, American Society of Nephrology Highlights, National Kidney Foundation (for being for being an invited speaker); from Ardea Biosciences (for random surveys and questionnaires); from Ironwood Pharmaceuticals (for serving on the Renal Event Adjudication Committee); and from Lesinurad (as advisory board member). V.D. Niyyar also reports having previous consultancy agreements with Ardea Biosciences and Lesinurad, and with Ironwood Pharmaceuticals (finished in December 2018); serving as a scientific advisor for, or member of, American Society of Nephrology (continuous cycler assisted peritoneal dialysis; 2018), American Society of Nephrology (interventional nephrology advisory group), and on the graft committee of Kidney Health Initiative–American Society of Nephrology/Food and Drug Administration; serving as the president-elect, and previous secretary treasurer and councilor, of ASDIN, and chair of the ASDIN hemodialysis vascular access Certification Committee and ASDIN US Certification Committee; and having other interests in/relationships with Commdex Consulting. M.K. Sharma reports serving on the editorial board of Annals of Internal Medicine; serving as a medical review board member of ESRD Network 15; serving on a speakers bureau for Relypsa; and having other interests in/relationships with University of Arkansas for Medical Sciences (Little Rock, AR) as adjunct faculty.

Background: Performing catheter-care observations in outpatient hemodialysis facilities are one of the CDC's core interventions, which have been proven to reduce bloodstream infections. However, staff have many competing responsibilities. Efforts to increase and streamline the process of performing observations are needed. We developed an electronic catheter checklist, formatted for easy access with a mobile device, and conducted a pilot project to determine the feasibility of implementing it in outpatient dialysis facilities., Methods: The tool contained the following content: ( 1 ) patient education videos; ( 2 ) catheter-care checklists (connection, disconnection, and exit-site care); ( 3 ) prepilot and postpilot surveys; and ( 4 ) a pilot implementation guide. Participating hemodialysis facilities performed catheter-care observations on either a weekly or monthly schedule and provided feedback on implementation of the tool., Results: The pilot data were collected from January 6 through March 12, 2020, at seven participating facilities. A total of 954 individual observations were performed. The catheter-connection, disconnection, and exit-site steps were performed correctly for most individual steps; however, areas for improvement were ( 1 ) allowing for appropriate antiseptic dry time, ( 2 ) avoiding contact after antisepsis, and ( 3 ) applying antibiotic ointment to the exit site. Postpilot feedback from staff was mostly favorable. Use of the electronic checklists facilitated patient engagement with staff and was preferred over paper checklists, because data are easily downloaded and available for use in facility Quality Assurance and Performance Improvement (QAPI) meetings. The educational video content was a unique learning opportunity for both patients and staff., Conclusions: Converting the CDC's existing catheter checklists to electronic forms reduced paperwork and improved the ease of collating data for use during QAPI meetings. An additional benefit was the educational content provided on the tablet, which was readily available for viewing by patients and staff while in the hemodialysis facility., Competing Interests: L. Golestaneh reports receiving compensation from the Cardiovascular Research Foundation for fulfillment of duties as a member of the clinical events committee for the Spyral Hypertension trials, sponsored by Medtronic; and receiving honoraria from Horizon Pharmaceuticals. A. Kliger reports having consultancy agreements with ASN and National Institute of Diabetes and Digestive and Kidney Diseases; having other interests/relationships with ASN and Renal Physicians Association; being a scientific advisor for, or member of, Qualidigm (quality-improvement organization); and receiving honoraria for lectures, seminars, and webinars from several universities, medical schools, and professional organizations. M. Mokrzycki reports receiving compensation from the Cardiovascular Research Foundation for fulfillment of duties as a member of the Clinical Events Committee for the following clinical trials: Medtronic Global Simplicity Registry, Medtronic Spyral HTN On/Off Meds, RECOR MEDICAL/RADIANCE II, Medtronic Spyral Dystal trial, and BOA GARNET trial; and receiving honoraria from Spherix Global Insights. V. Niyyar reports receiving honoraria as invited faculty for Albert Einstein–Montefiore and KidneyCon; receiving honoraria for being an invited speaker for the American Society of Diagnostic and Interventional Nephrology (ASDIN), American Society of Nephrology (ASN), ASN Highlights, and National Kidney Foundation; receiving honoraria from Ardea Biosciences; having previous consultancy agreements with Ardea Biosciences, Ironwood Pharmaceuticals (finished December 2018), and Lesinurad; being a scientific advisor for, or member of, the ASDIN (as president elect, previously secretary treasurer and councilor, chair, US certification committee, Hemodialysis Vascular Access certification committee), ASN Committee of Continuing Professional Development – 2018, ASN Interventional Nephrology Advisory Group, and Kidney Health Initiative – ASN/Food and Drug Administration (as member of the graft committee); having other interests/relationships with Commdex Consulting; receiving honoraria for serving on the renal event adjudication committee for Ironwood Pharmaceuticals; receiving honoraria for being on the advisory board for Lesinurad. All remaining authors have nothing to disclose., (Copyright © 2021 by the American Society of Nephrology.)

The cannulation technique of a hemodialysis vascular access has remained controversial with differing viewpoints. The quality of dialysis, overall patient safety, and individual dialysis experience often dictate the type of cannulation technique used in clinical practice. The three commonly used techniques to access a hemodialysis vascular access are the rope ladder, area, and buttonhole. Although the buttonhole technique has been around since the mid-1970s, the dialysis community remains divided on its suitability for routine use to provide maintenance hemodialysis therapy. The proponents of this technique value the ease of cannulation with less pain and discomfort whereas the opponents highlight the increased risk of infection. The actual clinical evidence from the United States is limited and remains inconclusive. The current review provides an overview of the available experience from the United States, highlighting the correct technique of creating a buttonhole, summarizing the current evidence, and recommending a need for larger randomized controlled studies in both in-center and home hemodialysis populations., Competing Interests: K. Abreo, M. Mokrzycki, V. Niyyar, T. Vachharajani, and L. Wong have nothing to disclose., (Copyright © 2020 by the American Society of Nephrology.)