Proper cannulation of the arteriovenous fistula is crucial for effective and safe haemodialysis. This chapter reviews established cannulation methods, including rope-ladder, area, and buttonhole techniques, outlining their indications, benefits, and risks. It also presents decision-making models that consider patient-specific factors, fistula characteristics, and staff expertise to guide technique selection. A new classification framework for cannulation techniques is introduced, aiming to standardize practice and support clinical training. Emphasis is placed on preserving arteriovenous fistula integrity, reducing complications, and optimizing dialysis efficiency. A structured, tailor-made approach to cannulation enhances access longevity and contributes to improved patient outcomes.