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There is no solid data on how many dialysis facilities and home hemodialysis programs in the United States are cannulating arteriovenous fistulas via the Buttonhole Technique. In the Pacific Northwest (Northwest Renal Network #16), approximately 38% of facilities are utilizing the buttonhole technique. In this article, four of those facilities will share their experiences, which suggest the Buttonhole Technique is a viable AVF cannulation option that has fewer complications than site rotation and a higher level of patient satisfaction.