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A successful hemodialysis therapy depends on the cannulation of arteriovenous fistulas (AVFs). The common fistula cannulation technique i.e. rope-ladder is challenging for patients having limited or shorter fistula length. On the other hand buttonhole technique is safe and easy for cannulation but it can only be applied to native fistulas, and a "single-sticker" is the best tool for cannulation. The purpose of this research was to assess how both cannulation approaches affected the survival of AVF patients. Our study aim is to identify the impact of cannulation techniques on arteriovenous fistula survival in Hemodialysis patients as well as to identify which cannulation technique has a lower rate of AVF complication. This is a cross sectional descriptive study carried out in the duration of four months.the sample size in this study was 154 patients in institute of kidney disease Peshawar. The result of this thesis is prepared through proforma,which having 14 question. A comparison was made between 59 patients who used the rope-ladder approach and 95 frequent hemodialysis patients with AVF who followed the BH technique. The following parameters were registered: hematoma occurrence, redness, swelling, aneurysm formation, the use of sharp or dull needles, miscannulations, and interventions. A verbal rating scale (VRS) was used to evaluate needle pain and puncture phobia. Data was analyzed with the help of SPSS version 23. A total of 154 patients were enrolled in which 88(57.1%) were males, 66(42.9%) were females who had hemodialysis access with BHC or RL technique were included in the study.The AVF survival in buttonhole cannulation technique is 50(58%) while in rope ladder cannulation technique is 59(85%)..The frequency of infection in buttonhole cannulation is 36 while in rope ladder cannulation is 20. Results concluded a significant. This investigation showed that patients who are male, younger in age, non-diabetic, have a lower BMI, have no history of cardiovascular disease, and can help with compression have a substantial benefit for access survival. Comparing the BH approach to the rope-ladder method, access infections were more common, which was a drawback.

Keywords: Arteriovenous Fistula Survival, Buttonhole Cannulation, Rope Ladder Cannulation, Hemodialysis.