It was an 8-week prospective, open-label, randomized controlled trial. Patients often chose arteriovenous fistula cannulation with the buttonhole technique, but it was linked to increased infection risk. There was no agreement on whether it should have been abandoned, so tested a quick and easy method for gentler arteriovenous fistula implantation with the potential to cause less discomfort and damage to the buttonhole tract’s epithelial lining. The participants were assigned to the intervention or control groups in a double-blind, parallel-group trial comparing buttonhole tract hemodialysis at 7 Norwegian dialysis centers. On the arm of the intervention group, the created buttonhole tract was delineated. There was no structured cannulation data system in the control group to indicate and measure the direction and angle of the established buttonhole tract. The research’s primary endpoint was cannulation, which was determined by the successful placement of both blunt needles on the first attempt without the need to alter needles, perform extra perforations, or relocate the needle. The secondary outcomes were cannulation difficulty (verbal rating scale: 1=very easy, 6=impossible) and pain intensity (numeric rating scale: 0=no pain, 10=unbearable pain).In the intervention group, successful cannulation rates were 73.9% and 74.8% at 2 weeks in the patients who had undergone a 2-week run-in period (RR, 0.99; 95% CI, 0.87-1.12; P=0.85). The rate of difficult arterial cannulation (verbal rating scale, 3-6) was also reduced in the intervention group (RR 0.69; 95% CI 0.55-0.85; P=0.001). Venous cannulations did not improve. Furthermore, the incidence of painful cannulation was lower in the intervention group (RR, 0.72; 95% CI, 0.51-1.02; P=0.06). Because of the small sample size, researchers could not assess hard endpoints such as infections and thrombosis. Cannulation success rates were not improved when cannulae were marked in direction and angle; nevertheless, patients reported a simpler procedure and less pain.