Research Into Pain Perception With Arteriovenous Fistula (Avf) Cannulation

Abstract

Patients with end-stage renal failure (ESRF) undergoing haemodialysis (HD) are repeatedly exposed to stress and pain from approximately 300 punctures per year to their arteriovenous fistula (AVF). Repeated AVF punctures lead to a considerable degree of pain, due to the calibre and length of the bevel of fistula needles. Pain is a sensitive, emotional and subjective experience. The objective of this study was to measure pain associated with AVF needling. The analogue visual scale (AVS) divided into 10 equal parts (0 indicating lack of pain, and 10 unbearable pain) was used. Patients(7) perceptions were measured in three different HD sessions. Pain was considered mild during AVF needling. The buttonhole technique caused a mean degree of pain of 2.4 (+/-1.7), compared to 3.1 (+/-2.3) using the conventional ropeladder technique. Although without reaching a statistically significant difference, diminished pain was associated with the buttonhole technique.

Experiência inicial com a técnica de Buttonhole em um centro de hemodiálise Brasileiro

“…Some patients were so satisfied with the technique that they even asked not to go back to the RL technique. 7,[9][10][11]14,27 The loss of two accesses (9.5%) due to complications was considered high, as was the occurrence of clots in 47.6% of the patients. However, such intercurrences resulted mainly from the change in cannulator and did not relate to the use of tobacco, contraceptives, and platelet antiaggregating agents, nor to any difficulty in tunnel track formation.…”

“…The BH technique, described by Twardowsky et al in 1977, was used initially for patients with short arteriovenous fistula (AVF) lengths and severe pain due to alternate cannulations and, later, for self-cannulation of patients undergoing home hemodialysis. [7][8][9][10][11][12][13][14][15] Currently, the introduction of daily hemodialysis and the consequent increase in the number of cannulations per week can represent an additional indication for the BH technique, although some studies have shown that a greater number of cannulations per week does not necessarily relate to a reduction in vascular access survival. 9 Aiming at assessing the usefulness and efficacy of the BH technique in daily clinical practice, a protocol for creating and cannulating AVF according to the BH technique has been introduced in our service.…”

Efficacy of application of eutectic mixture of local anesthetics and lidocaine spray in pain management of arteriovenous fistula cannulation in hemodialysis patients

“…In the clinical setting, pain is produced during the performance of various diagnostic and therapeutic interventions among such as venous catheter or cannulation for therapeutic purposes in hospital (7). In hemodialysis patients, the most common cause of pain is the arteriovenous fistula (AVF) cannulation due to the diameter and length of these catheters (8). On average, the hemodialysis patients undergo the procedure three times a week, each time lasting 3-4 hours.…”

Effect of warm footbath with vibration on arteriovenous fistula puncture-related pain in hemodialysis patients

“…5 For a hemodialysis patient there is nothing more stressful than being exposed by big needles in the arteriovenous fistula site frequently; hence, most of these patients speak about the puncturing process as their most common difficulties. 6,7 As sometimes more than one try to place these needles correctly while accessing the suitable blood circulation is needed, doing hemodialysis three times a week makes the patient expose to the skin bore and pain approximately 300 times per year. 6,8 Therefore, decreasing part of these side-effects is so important to increase patients' coping with hemodialysis.…”

“…6,7 As sometimes more than one try to place these needles correctly while accessing the suitable blood circulation is needed, doing hemodialysis three times a week makes the patient expose to the skin bore and pain approximately 300 times per year. 6,8 Therefore, decreasing part of these side-effects is so important to increase patients' coping with hemodialysis. 9 Thermotherapy is one of the simple, safe, cheap and effective non-pharmacological interventions which can decrease the pain based on the gate-control theory.…”