Pain Degree and Skin Damage During Arterio‐venous Fistula Puncture

Abstract

K e Y W o r d s • Vascular access • Arteriovenous fistula • Puncture pain • Fistula damage • Needle bevel position B i o d a t a Rodolfo Crespo has worked in renal care since 1981 and was appointed Chief of Renal Nurse Staff at the Chronic Dialysis Unit in 1987. He has been a Lecturer in Medical Nursing at the University of Córdoba since 1990. His research activity is focused on vascular access of the renal failure patient and work related to nurse management.The aims of this study were to evaluate the effect of needle bevel position on the degree of pain and damage to the skin covering the vein, in an arteriovenous fistula puncture, in haemodialysis patients. 48 patients with autologous arteriovenous fistula were studied. After puncture the patient was asked about the degree of pain perceived by means of an analogue visual scale and a descriptive verbal scale. When the needle was removed, the length of the cut made by the puncture was measured. The perceived pain assessed by analogue visual scale was greatest when the needle was punctured with the bevel facing upwards rather than downwards (median: 3 versus 2, p<0.003). The prick in the skin was greater when the puncture was made with the bevel facing upwards (19.7±5.6) rather than downwards (16.2±3.8, p<0.0001). It is concluded that arteriovenous fistula puncture with the bevel facing downward significantly reduces the degree of pain and the skin lesion at the point of puncture, without increasing the number of punctures.

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]…”

“…6 Indeed, pain related to exposure to at least three punctures per week was reported as a major challenge by 57% of patients treated with hemodialysis. 7 Second, it may increase nonadherence to recommended dialysis regimen, 8 and thus increase mortality rate due to increase in cardiovascular and respiratory complications. 7 Second, it may increase nonadherence to recommended dialysis regimen, 8 and thus increase mortality rate due to increase in cardiovascular and respiratory complications.…”

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

“…8,11,14,18,[20][21][22][23][24][25][26][27] In addition, partial and even complete elimination of pain was observed in some patients with longer AVF use. Some patients were so satisfied with the technique that they even asked not to go back to the RL technique.…”

“…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.…”