Effect of cryotherapy on pain management at the puncture site of arteriovenous fistula among children undergoing hemodialysis

Abstract

Objective To evaluate the effectiveness of cryotherapy in managing the pain at the puncture site of Arterio-Venous Fistula (AVF) among children undergoing maintenance hemodialysis (HD). Methods A one-group pre-post quasi-experiment was performed in two HD centers affiliated with Cairo University. The experiment involved 40 children with AVF undergoing HD. Before puncturing, cryotherapy was applied using 2 cm–3 cm pieces of frozen distilled water in a plastic bag. Pain was assessed subjectively and objectively in two dialysis sessions before and after cryotherapy. A part from a physiological assessment of vital signs, pain was assessed using the Wong–Baker Faces Pain and the Observed Pain Behavior rating scales. All research ethics were applied. Results HD had a median duration of four years, while cryotherapy had a median application time of 8.8 min. The Wong–Baker Faces Pain score and almost all observed pain behaviors significantly decreased after cryotherapy. Significant improvements were observed in respiratory rate before and after needle puncture and in oxygen saturation after needle puncture. A lower skin dryness was observed after cryotherapy (12.5%) than before cryotherapy (52.5%; p < 0.001). Conclusions Cryotherapy can effectively reduce the venipuncture pain among children with AVF undergoing maintenance HD. However, the confounding effects of distraction and the non-randomized design used must be both considered when interpreting the findings. This study recommends the use of cryotherapy in managing needle puncture pain. Further research must adopt a randomized trial design with a placebo to support further the benefits of this procedure.

Management Strategies for Pain Associated with Arteriovenous Fistula Cannulation: An Integrative Literature Review

“…The studies included in the review were published between 2004 and 2019. 8,[12][13][14][15][16][17]19,20,22,24,[26][27][28]30,[32][33][34][40][41][42]44 The reviewed literature indicated that the majority of patients being dialyzed using arteriovenous fistulas or grafts reported a moderate degree of cannulation pain. The designs of the selected studies were randomized controlled trials (n = 14; 40%), 5,10,18,21,23,25,[29][30][31][35][36][37][38][39] and observational studies (n = 21; 60%).…”

“…No studies were found prior to 2004. In 66% (n = 23) of the reviewed articles a visual analog scale (VAS) was used to assess pain, 5,8,10,12,[14][15][16][17][18][19][20][21][22][23]30,32,34,[36][37][38][39]42,44 while in 22% (n = 8) a numerical rating scale (NRS) was used 13,24,25,29,31,35,40,41 ; three studies (8%) used the Wong-Baker scale, 26,27,33 and one study (3%) used a structured interview questionnaire and a subjective pain assessment tool. 8,[12][13][14][15][16][17]19,20,22,24,[26][27][28]30,[32]…”

“…8,[12][13][14][15][16][17]19,20,22,24,[26][27][28]30,[32][33][34][40][41][42]44 The reviewed literature indicated that the majority of patients being dialyzed using arteriovenous fistulas or grafts reported a moderate degree of cannulation pain. 27,29,31 After reviewing the retrieved articles, the following major pain management strategies were identified: The first strategy was the use of specific cannulation techniques to mitigate needle insertion pain, the second strategy was the use of alternative complementary methods for pain control, and the last strategy was the use of local anesthetic agents. 28 Observed pain behavior rating scales were used in three articles together with the subjective tools for further validations of the results.…”

“…The designs of the selected studies were randomized controlled trials (n = 14; 40%), 5,10,18,21,23,25,[29][30][31][35][36][37][38][39] and observational studies (n = 21; 60%). 8,[12][13][14][15][16][17]19,20,22,24,[26][27][28]30,[32][33][34][40][41][42]44 The reviewed literature indicated that the majority of patients being dialyzed using arteriovenous fistulas or grafts reported a moderate degree of cannulation pain. In 66% (n = 23) of the reviewed articles a visual analog scale (VAS) was used to assess pain, 5,8,10,12,[14][15][16][17][18][19][20][21][22]…”

“…24 Another study founded that a low level of cannulation pain could be achieved by soaking the patient's feet in warm water (40 C) for 10 minutes before inserting the fistula needle. [26][27][28][29][30][31]37 Distraction interventions were also described. 44 Another approach was to apply cold therapy (cryotherapy) 10 minutes before cannulation to the arm contralateral to the fistula arm, at an acupuncture point on the dorsum of the hand between the thumb and forefinger (the so-called "Hegu" point 45 ), and this method was found to reduce cannulation pain significantly.…”