Arteriovenous Fistula Cannulation, Hemodialysis, Procedural Pain
Conditions
Keywords
Hemodialysis, arteriovenous fistula, acupressure, music therapy, procedural pain, nursing care
Brief summary
This randomized controlled trial was conducted to evaluate the effect of music-assisted acupressure on pain experienced during arteriovenous fistula (AVF) cannulation in hemodialysis patients. The study was carried out with 72 patients receiving hemodialysis treatment three times per week via AVF in a state hospital in Gaziantep, Türkiye. Participants were randomly assigned to one of four groups: music-assisted acupressure, acupressure alone, music alone, and control group (routine care). The acupressure intervention was applied to the Hegu (LI4) point for approximately 3 minutes prior to needle insertion, while the music intervention consisted of listening to instrumental Classical Turkish Music in the Acemaşiran mode through headphones starting 5 minutes before cannulation and continuing until the end of the procedure. Pain intensity during AVF cannulation was measured using the Visual Analog Scale (VAS) during three consecutive dialysis sessions. The primary outcome was pain severity during needle insertion. The study aimed to determine whether combining music therapy and acupressure would provide greater pain relief compared to single interventions or routine care. Findings suggest that music-assisted acupressure may be an effective non-pharmacological nursing intervention for reducing procedural pain in hemodialysis patients.
Detailed description
This study was designed as a randomized controlled trial to investigate the effect of music-assisted acupressure on procedural pain during arteriovenous fistula (AVF) cannulation in patients undergoing hemodialysis. The study was conducted between March and November 2024 in the hemodialysis unit of a state hospital in Gaziantep, Türkiye. A total of 72 eligible patients receiving hemodialysis treatment via AVF were included. Patients were randomly assigned into four equal groups (n=18 per group): music-assisted acupressure, acupressure, music, and control. Randomization was performed using a simple lottery method. All AVF cannulation procedures were performed by the same experienced dialysis nurse to ensure procedural consistency. The acupressure intervention was applied to the Hegu (LI4) point on the hand contralateral to the AVF site. Finger pressure was applied perpendicularly for approximately 3 minutes prior to needle insertion. The music intervention consisted of listening to instrumental Classical Turkish Music in the Acemaşiran mode through headphones, beginning 5 minutes before cannulation and continuing until the end of the procedure. Participants in the combined intervention group received both acupressure and music simultaneously using the same protocols described above. The control group received routine hemodialysis care without additional intervention. Pain intensity during AVF cannulation was assessed using the Visual Analog Scale (VAS, 0-10) immediately after each procedure. Measurements were repeated over three consecutive hemodialysis sessions. Sociodemographic and clinical data were also collected using a structured patient information form. The primary outcome of the study was pain intensity during AVF cannulation. Data were analyzed using non-parametric statistical tests due to non-normal distribution, including Kruskal-Wallis, Friedman, and Brunner-Langer models for repeated measures. Statistical significance was set at p \< 0.05.
Interventions
OTHERMusic Therapy
Participants listened to instrumental Classical Turkish Music in the Acemaşiran mode through headphones starting 5 minutes before AVF cannulation and continuing until the end of the procedure.
OTHERAcupressure
Manual acupressure applied to the Hegu (LI4) point on the hand contralateral to the AVF site for approximately 3 minutes prior to AVF cannulation.
OTHERMusic-Assisted Acupressure
Listening to instrumental Classical Turkish Music (Acemaşiran mode) via headphones starting 5 minutes before AVF cannulation and continuing throughout the procedure.
OTHERStandard Care
Routine hemodialysis care without additional music or acupressure intervention during AVF cannulation.
Sponsors
Gülsüm Gülşen
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
TREATMENT
Masking
NONE
Masking description
No blinding was applied in this study. Due to the nature of the interventions (music therapy and acupressure), participants, care providers, and investigators were not blinded. Outcome assessment was performed by the same researcher who collected the data; therefore, no additional masked parties were included.
Intervention model description
This study employed a 2×2 factorial randomized controlled design to evaluate the independent and combined effects of music therapy and acupressure on procedural pain during arteriovenous fistula (AVF) cannulation in hemodialysis patients. Participants were randomly assigned to one of four groups: music-assisted acupressure, acupressure only, music only, or routine care (control). This design allowed the assessment of main effects of each intervention as well as their potential interaction effect on pain intensity measured by the Visual Analog Scale (VAS).
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years * Receiving hemodialysis treatment three times per week * Presence of an arteriovenous fistula (AVF) for vascular access * Ability to communicate in Turkish * No use of analgesic medication prior to AVF cannulation * No pain or pathology in the upper extremities that could affect intervention application or pain assessment * Willingness to participate in the study and provide informed consent
Exclusion criteria
* Diagnosis of neuropathy * History of upper extremity surgery or soft tissue injury * Presence of bleeding disorders or coagulation disorders * Diagnosis of heart failure * Presence of a pacemaker * Inability to comply with study procedures or complete data collection * Any condition that could interfere with pain perception or the application of acupressure or music intervention
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain Intensity During AVF Cannulation (VAS Score) | During each hemodialysis session over 3 consecutive sessions (March-November 2024) | Pain intensity experienced during arteriovenous fistula (AVF) cannulation was assessed using the Visual Analog Scale (VAS), ranging from 0 (no pain) to 10 (worst imaginable pain). Measurements were obtained immediately after each cannulation procedure across three consecutive hemodialysis sessions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Pain Scores Over Time | Baseline and across 3 consecutive hemodialysis sessions | Changes in pain intensity across repeated AVF cannulation procedures were evaluated to assess the consistency and trend of intervention effects over time among study groups. |
Countries
Turkey (Türkiye)
Outcome results
None listed