The paper discussed during autumn 2007 was a report entitled ‘Cannulating in haemodialysis: rope-ladder or buttonhole technique?’ published in Nephrology Dialysis Transplantation. The authors agreed to follow the discussion and respond to points raised. Twenty-three expert contributors from 13 different countries provided evidence, opinion and historical insights into vascular access techniques for chronic haemodialysis patients. All contributors who had introduced the buttonhole technique for patients with native arterio-venous fistulas (AVFs) had found benefits for patients in terms of ease of cannulation, reduced pain and even reduced aneurysm formation. The discussion included expert advice on needling protocols, track formation and the sharp versus blunt needles debate. The buttonhole technique is virtually unheard of in some countries and the discussion covered some of the potential barriers to its introduction and offered advice on also how to overcome some of these issues.