Pain associated with arteriovenous fistula cannulation: Still a problem

CONTEXT: Puncture-related pain during arteriovenous fistula cannulation is a crucial influential factor in the quality of life of chronic hemodialysis patients. OBJECTIVES/METHODS: In this prospective single center study, we used a questionnaire to evaluate the patterns of pain of arteriovenous fistula cannulation in a group of hemodialysis patients. RESULTS: From a total of 123 eligible patients with arteriovenous fistula invited to participate, 83 (58 M/25 F) (median age 58 y.o.) returned questionnaires. Sixty-five benefitted from an analgesic intervention on cannulation, and 62 found this intervention effective. We evaluated the pain intensity with the échelle visuelle analogique score, the equivalent of Visual Analogue Scale score in French. No specific analgesic intervention (lidocaine patch or cream, vapocoolant spray) was more effective than the others (pNS). 30/65 patients with and 10/18 patients without analgesic intervention reported pain on cannulation (échelle visuelle analogique>1) (pNS). 21/65 patients with and 6/18 patients without analgesic intervention reported pain on needle retraction (pNS). Forty of the 65 patients with analgesic intervention and 11/18 patients without intervention feel stressed before each cannulation. The stress of arteriovenous fistula-related pain is significantly associated with a sensation of pain on cannulation (P=0.047) and needle retraction (P=0.002). CONCLUSION: Despite prophylactic measures for arteriovenous fistula cannulation pain, patients frequently experience stress and unpleasant sensations associated with the procedure.