Pain Of Cannulation Research Articles

The effect of using a local skin cooling device on arteriovenous fistula cannulation pain and comfort level of patients on hemodialysis: A single-blind randomized controlled study.

The study aimed to investigate the impact of the using local skin cooling on arteriovenous fistula cannulation pain and the comfort levels of hemodialysis patients. The single-blind randomized controlled trial was formed with 50 patients between June 20, 2023, and July 31, 2023, in the hemodialysis units of two state hospitals in Turkey. Patients were randomly assigned to either the experimental group (n = 25) or the control group (n = 25) using the block randomization method. This data were collected through the use of the CoolSense device, the "Patient Information Form," the "Verbal Category Scale," and the "General Comfort Scale." Patients in the experimental group received the local skin cooling for five seconds during arteriovenous fistula cannulation, while the control group followed the standard hospital protocol. The study was registered on Clinical Trials (NCT06144801). The study revealed that the application of the local skin cooling during arteriovenous fistula cannulation significantly reduced pain and increased patients' comfort levels, demonstrating an anesthetic effect (p < 0.001). Furthermore, it was observed that as pain levels decreased, patient comfort levels increased (p < 0.001). It is concluded that the using lokal skin cooling is an effective tool for reducing pain and enhancing comfort during arteriovenous fistula cannulation in hemodialysis patients.

Effect of Cold Application on Pain Relief during Intravenous Cannulation for Cancer Patients

Background: The cannulation of intravenous Analgesia is rarely experienced after this unpleasant procedure, which can also induce stress and worry. Objective: The purpose of the study was to ascertain how cold affected the degree of pain during intravenous cannulation. Methodology: A randomized controlled trial was carried out at the oncology department of AL-Al-Haboubi Teaching Hospital in Dhi-Qar from January 4, 2024, until February 3, 2024. After the sample was selected, 102 patients were divided into two groups in order to achieve the study's objective: 50 patients were assigned to the control group and 52 patients to the experimental group. The experimental group was given cold gel, and self-report data collection was used. A visual analogue scale of 10 cm was used to measure pain. Results: The experimental group's post-test results showed a low mean pain score (28.76+20.491), while the control group's data analysis results showed a high mean score (M+SD 76.54+20.427) and severe discomfort during cannulation insertion. The mean pain score during cannulation insertion varied significantly (p=.001) between the experimental and control groups following the use of cold treatment. Conclusions: According to the study's findings, the cool approach helped to lessen intravenous cannulation pain. Recommendations: The study advised patients to be chilled when receiving intravenous cannulation.

PEMIJATAN TITIK LI-4 DAPAT MENGURANGI NYERI KANULASI ARTERIOVENOUSFISTULA PADA PASIEN CKD YANG MENJALANI HEMODIALISA: STUDI KASUS

Background, one of the vascular accesses used for hemodialysis is arteriovenous fistula. Arteriovenous fistula cannulation causes pain problems in patients. The cannulation procedure is felt as a painful sensation that needs to be treated, because the size of the needle used when cannulating an arteriovenous fistula is quite large compared to cannulating when installing an IV, namely 16 gauge. General purpose, to provide acute pain nursing care for Chronic Kidney Disease (CKD) patients undergoing hemodialysis in the hemodialysis room at RSU Aghisna Medika Kroya. Case collection method, pain scale measurement using a VAS instrument for 5 CKD patients undergoing hemodialysis without massage intervention and with massage intervention at the LI-4 point for 2 minutes or approximately 30-50 pressures. The results of nursing care, nursing care for acute pain in CKD patients undergoing hemodialysis after nursing for 1x4 hours with the application of massage at point LI-4 showed a decrease in the pain scale in patients without massage and with massage at point LI-4. In conclusion, LI-4 point massage therapy can be an therapeutic option to reduce the pain of arteriovenousfistula cannulation in CKD patients undergoing hemodialysis. Recommendation is hoped that more and larger case subjects will be taken in the next research so that the results will be more effective.

The effect of cold packs, lidocaine spray, and flashlights on cannulation pain in patients undergoing hemodialysis: a randomized controlled trial

BackgroundPain is a frequent and critical problem in daily hemodialysis practice. The pain experienced during arteriovenous fistula cannulation varies from 12% to even 80% in hemodialysis patients depending on the pain assessment tools used. Pain can lead to sleep problems, decreased compliance with hemodialysis therapy, frequent hospital hospitalizations, a decline in quality of life, and high death rates. Despite utilizing several methods as pain relief, it is still unknown in the literature and practice which method is the most effective. The purpose of the study was to compare the effect of lidocaine spray, cold packs, and flashlights on the pain induced by arteriovenous cannulation in hemodialysis patients. This was a prospective randomized open-label controlled trial. Hundred and eight adult patients on regular hemodialysis were recruited and simply randomized into one of four groups (lidocaine spray, cold packs, flashlights, and control) before cannulation.ResultsThe mean pain severity using visual analog scale was 4.3 (3.3–5.7) in lidocaine group, 4 (3–5.7) in cold packs group, 4.3 (3.3–5.3) in flashlight group, and 4.7 (3–6) in control group. There was a borderline significant difference between groups using Kruskal–Wallis test (p = 0.054). The post hoc Tukey test showed that only cold packs differ from control group with borderline significance (p = 0.051).ConclusionThe results showed that cold packs were safe and effective than lidocaine spray or flashlights in reducing cannulation pain. It is suggested to implement this method before cannulation in hemodialysis patients to reduce pain and improve quality of life. Future studies are needed to compare different application times of cold packs and its impact on pain scores to recommend the optimum time needed to achieve maximum analgesic effect.Trail registration: Clinical trials.gov NCT05822063, REC #194.Graphical abstract

Dialysis Needle-Related Distress: Patient Perspectives on Identification, Prevention, and Management

Needle-related distress is common among people receiving hemodialysis and affects quality of life and treatment decisions, yet little evidence exists to guide management. This study explored patients' experiences of needle-related distress to inform the development of prevention, identification, and management strategies. Semistructured interviews concerning dialysis cannulation, needle-related distress, and potential solutions were conducted with people with current or recent experience of hemodialysis (N= 15) from a tertiary hospital-based service. Interviews ceased at thematic saturation. Transcripts were analyzed thematically. There were 4 themes and 11 subthemes generated: (i) uncovering a hidden source of distress (dismissal and minimization by others; suffering in silence to stay alive; preparation, assessment, and education); (ii) coping with cannulation pain and trauma (interaction between physical damage, pain, and distress; operator dependency-the importance of nurse skill and technique); (iii) the environment created by dialysis nurses (emotional transference; communication during cannulation; valuing empathy and person-centered care; a psychosocially supportive dialysis unit); and (iv) supporting patient self-management of distress (accessing tools to help themselves; distraction to reduce distress). Needle-related distress is an often-hidden element of the hemodialysis experience. Patients learn to tolerate it as an inevitable part of dialysis for survival. Nurses' technical skills and the dialysis environment they create are key determinants of the patient cannulation experience. Proposed solutions include psychological screening, education for patients to self-manage distress, and training for nurses in communication and providing relevant psychological support.

The Effect of Islamic Music Therapy for Reducing Pain in CKD Patients Undergoing Hemodialysis

When patients with CKD are receiving hemodialysis, cannulation is frequently performed. For hemodialysis patients, recurrent pain during cannulation is a severe issue. Even though there have been many studies on music therapy, there are currently few on Islamic music therapy’s effectiveness in easing cannulation pain. The study aimed to determine the effect of Islamic music therapy in reducing pain in CKD patients undergoing hemodialysis. This study used a pre-experimental design. 61 hemodialysis patients at Wava Husada Hospital were subjects of the study. They were split into two groups: the Islamic music therapy intervention group and the control group. In this study, non-probability sampling was conducted. Inclusion requirements included being Muslim, receiving hemodialysis for CKD, using AV fistula access, and not being in critical condition. Following the intervention, the NRS pain scale was used to assess the level of pain in each respondent. This study discovered that the control and Islamic music therapy intervention groups experienced different levels of discomfort. This study’s P value was 0.001 (0.05) according to the Mann-Whitney statistical test. Based on the findings of this study, it can be said that using Islamic music therapy to treat hemodialysis patients with chronic kidney disease can help them feel less pain.&#x0D; Keywords: Islamic music therapy, Pain, Hemodialysis

The effect of using vapocoolant spray for pain reduction in arteriovenous fistula cannulation among patients undergoing hemodialysis: A randomized control trial

AimThe aim of this study was to assess the effects of alkane vapocoolant spray in reducing pain during arteriovenous access cannulation in adult patients undergoing hemodialysis. BackgroundDeveloping and applying various approaches for pain relief remain important responsibility for nurses. MethodsThis study was designed as an experimental study with a cross-over design. Thirty-eight patients on hemodialysis volunteered to undergo cannulation of their arteriovenous access, after the application of vapocoolant or placebo spray or no intervention. Subjective and objective pain levels were assessed, along with various physiological parameters pre- and post-cannulation. ResultsStatistically significant between-group differences were observed in subjective pain at the venous (F = 4.97, p = 0.009) and arterial (F = 6.91, p = 0.001) puncture sites. The mean arterial site subjective pain scores were 4.45 ± 1.31 (no treatment), 4.04 ± 1.82 (placebo), and 2.98 ± 1.53 (vapocoolant spray). Significant between-group differences were observed in objective pain scores during arteriovenous fistula puncture (F = 5.13, p = 0.007). The mean objective pain scores after arteriovenous fistula puncture were 3.25 ± 2.66 (no treatment), 2.17 ± 1.76 (placebo), and 1.78 ± 1.66 (vapocoolant spray). Post-hoc test results indicated vapocoolant spray application was associated with significantly lower pain scores than no treatment or placebo. Patient blood pressure and heart rate recordings did not differ among the interventions. ConclusionVapocoolant application was significantly more effective than the placebo or no treatment in reducing the pain of cannulation in adult patients undergoing hemodialysis.

A comparative study of 10% lidocaine spray versus eutectic mixture of 2.5% lidocaine and 2.5% prilocaine (EMLA) to attenuate pain of peripheral venous cannulation in children: A prospective randomized control trial at a tertiary care centre.

Eutectic mixture of local anesthetics (EMLA) (2.5% lidocaine and 2.5% prilocaine) cream is the commonly used topical anesthetic for painful intradermal procedures. Topical 10% lidocaine spray has successfully been used to anesthetize mucosal surfaces. Owing to its skin penetrative properties, this study was conducted to compare dermal analgesia between 10% lidocaine spray and EMLA cream for intravenous (IV) cannulation in children. In this prospective single-blind randomized study, ninety-nine Paediatric patients were assigned into Group A (number(n) =51) with Lignocaine 10% spray applied 10 minutes and Group B (n = 48) EMLA cream applied 1 hour prior to cannulation. Vital signs were recorded before, during, and after the procedure. The primary objective of the study was assessment of severity of pain during IV cannulation using 10 cm visual analogue scale (VAS). Secondary objectives such as ease of cannulation and adverse effects were also noted. All cannulations were performed in the first attempt with no adverse effects in both lidocaine group and EMLA group. The median (interquartile range) VAS score was 2 cm (1 to 3) in both the groups with a P value of 0.58. Topical 10% lidocaine spray applied ten minutes before venous cannulation is as effective as EMLA cream applied an hour before cannulation in children in providing dermal analgesia for intravenous cannulation with an added advantage of rapid onset of action in the former group.

Effect of the arterial needle bevel position on puncture pain and postremoval bleeding time in hemodialysis patients: A self-controlled, single-blind study.

This study aimed to investigate the effect of the bevel orientation (facing upwards or downwards towards the skin) of the needle inserted into the arterial limb of the arteriovenous fistula (AVF) on puncture pain and postremoval bleeding time. This study, using a single-blind crossover design, was conducted on 35 maintenance hemodialysis patients who had been dialyzed for at least 6months and in whom blood access was via an AVF. AVF cannulation was performed with the needle bevel pointing upward in the first six sessions and the needle bevel pointing downwards (towards the skin) in the subsequent six sessions. Needles were always inserted in the direction of blood flow. At each dialysis session, cannulation pain was measured using a visual analog scale (VAS), and the bleeding time at the end of dialysis after needle removal was recorded. The VAS score and postremoval bleeding time were lower when the needle bevel pointed downwards towards the skin during insertion (P<0.05). Insertion of the needle with the bevel pointed downward decreased puncture pain during cannulation and bleeding time postdialysis on needle removal.

Comparison of the Effect of EMLA™ Cream and the Valsalva Maneuver on Pain Severity during Vascular Needle Insertion in Hemodialysis Patients: A Controlled, Randomized, Clinical Trial.

Background Pain due to vascular needle insertion has been reported in 40–60% of hemodialysis (HD) patients. Evidence suggests that there is typically no single method for relieving the pain of inserting vascular needles in HD patients. This study aimed to compare the effectiveness of EMLA cream and Valsalva maneuver (VM) on pain severity during vascular needle insertion in HD patients. Methods This randomized, controlled, clinical trial was conducted on 90 patients undergoing hemodialysis in the hemodialysis unit of Kowsar Hospital, affiliated with Semnan University of Medical Sciences, in Semnan, Iran. Patients were selected via convenience sampling and were randomly assigned to one of the three groups (EMLA, VM, and control groups). For the patients in the EMLA group, 2.5 g of EMLA cream was applied 60 minutes before the start of dialysis. For patients in the VM group, a maneuver was performed for 16–20 seconds before the needle was inserted. Patients in the control group received only routine care without any additional interventions. The pain severity in the three groups was measured using the visual analog scale (VAS) two minutes after vascular needle insertion. Results The results showed that the mean pain severity during cannulation was 2.06 ± 2.19 in the EMLA group, 3.2 ± 30.42 in the VM group, and 6.20 ± 1.49 in the control group, suggesting a significant difference between the groups (P < 0.001). Pairwise comparison of the mean pain severity showed that it differed significantly in the EMLA and VM groups from the control group (P < 0.001), but no significant difference was found between the EMLA and VM groups (P=0.067). Conclusion According to the results, EMLA cream was as effective as VM in reducing the pain severity caused by arteriovenous fistula (AVF) cannulation. Therefore, the use of EMLA cream and VM is recommended for reducing the severity of AVF cannulation pain. Trial Registration. Iranian Registry of Clinical Trials, Trial No : IRCT20120109008665N12, registered on 3 June 2020.

Comparison of music and vapocoolant spray in reducing the pain of venous cannulation in children age 6-12: a randomized clinical trial

BackgroundVenous cannulation is among the most stressful and painful experiences of children hospitalization. Children with thalassemia need regular blood transfusion which needs venous access each time. The quality of care and quality of life of children will be improved if appropriate methods are used to reduce pain. This study aimed to compare vapocoolant spray and music in the reduction of pain of Venous cannulation in children with thalassemia.MethodsThe study was a randomized controlled clinical trial with a cross-over design. Thirty-six children with thalassemia from Thalassemia Patients of Pasteur Hospital in Bam from October to December 2020 and were recruited and randomly allocated to two arms. The pain of venous cannulation (no treatment) was measured in the first blood transfusion session as control. In the second and third sessions, two arms received music and vapocoolant spray before the venous cannulation with a cross-over design. The intensity of pain was measured by a Visual Analogue Scale (VAS). The change in pain scores was tested by ANOVA and Tukey post-hoc test between three measurements.ResultsDuring and after the cannulation, the pain was significantly lower in the vapocoolant measurement than in control and music (p < 0.05). There was a significant effect of vapocoolant spray during the procedure F (2, 90) = 25.604, p = 0.001. Also, there was a significant effect of vapocoolant spray after the procedure F (2, 90) = 10.087, p = 0.004). Music did not reduce the pain during cannulation (p = 0.413) and after that (p = 0.807) significantly when compared with control.ConclusionsVapocoolant was an effective method of pain reduction in the reduction of venous cannulation pain. Music was not effective in the reduction of venous cannulation pain when we compared it with controls. The pain of venous cannulation is rated as high and it can have negative effects on the children. There is a need to do more research on the methods of pain reduction of venous cannulation.Trial registrationThe trial is registered: IRCT20111019007844N13, 13/03/2020. Available at: https://en.irct.ir/trial/42904.

Efficacy of Eutectic Mixture of Local Anesthetic Cream and Vibrator Device in Pain Reduction during Peripheral Venous Cannulation in a Tertiary Care Center of Central Nepal

Background Venous cannulation is a commonly performed procedure which often leads to patient anxiety. Application of a vibrator device and or prior use of topical anesthetics are proven methods to decrease associated pain.&#x0D; Objective To compare the clinical efficacy of prior use of Eutectic Mixture of Local Anesthetic (EMLA) cream and vibrator device in pain reduction during peripheral venous cannulation.&#x0D; Method A true experimental study was conducted in November 2019 among 78 patients aged 20-60 years receiving peripheral cannulation at operation theatre. They were included using consecutive sampling and sorted to interventional and noninterventional group using simple random sampling lottery method. Participants in the non-interventional group received peripheral cannulation using routine technique whereas participants in the interventional group received topical Eutectic Mixture of Local Anesthetic cream or vibrator device prior to cannulation. Perceived post cannulation pain intensity was measured using numerical pain rating scale. Kruskal-Wallis test was used for data comparison.&#x0D; Result The mean age of the participants was 40.57 ± 12.5 years. The median pain score of Eutectic Mixture of Local Anesthetic cream, vibrator and no intervention was 3, 3 and 6 respectively. The reduction in median pain intensity was significantly greater with topical anesthetic cream and vibrator device when compared to the noninterventional group (p &lt; 0.05).&#x0D; Conclusion Prior interventions with Eutectic Mixture of Local Anesthetic or vibrator device are useful in reducing pain intensity during peripheral venous cannulation. Routine use of these in day to day practice could be a part of standard nursing care practice.

A time-saving method of creating AVF buttonholes: indwelling trocar technique.

This study aims to explore the convenience and practicality of the method of establishing buttonholes with indwelling trocars. Compared with rope-ladder technique, buttonhole cannulation has better applicability for haemodialysis patients, and the method of buttonhole establishment is particularly important. Prospective, observational and cohort study. We conducted a 12-month observational study on 30 patients who used sharp needles to establish buttonholes and 33 patients who used indwelling trocars to establish buttonholes, and compared the differences between the two groups in the buttonhole formation time, patient-reported cannulation pain, buttonhole success rate, AVF-related infection and patency of AVF. The study adhered to STROBE guidelines. The buttonhole formation time of the indwelling trocar group is less than that of the sharp needle group (5.48±0.51 vs. 23.23±3.07, p<.01). When the buttonhole was used for the first time, the cannulation pain of the indwelling trocar group was less than that of the sharp needle group (4.94±1.50 vs. 6.03±1.13, p=.002), but there was no significant difference in this result after 1month (sharp needle group with 4.50±0.94 vs. indwelling trocar group with 4.12±1.19, p=.169). Compared with all the buttonholes in the indwelling trocar group were established successfully, there were 5 unsuccessful buttonholes in the sharp needle group (p=.02). Three cases of unsuccessful buttonhole patients in the sharp needle group developed AVF-related infection, this result did not appear in the indwelling trocar group (p=.102). The difference in arterial pressure and venous pressure between the two groups was not significant (p=.061, p=.222). Our new method can help buttonhole patients get less track formation time, less cannulation pain, and less fistula infection, thereby bringing them a more comfortable dialysis experience. The new method used in this study not only meets the needs of patients to protect AVF, but also provides convenience for clinical work. In addition, this study analyzed the causes of the AVF infection in buttonhole patients, and provided directions for future research.

Pain associated with arteriovenous fistula cannulation: Still a problem

ContextPuncture-related pain during arteriovenous fistula cannulation is a crucial influential factor in the quality of life of chronic hemodialysis patients. Objectives/methodsIn 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. ResultsFrom 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). ConclusionDespite prophylactic measures for arteriovenous fistula cannulation pain, patients frequently experience stress and unpleasant sensations associated with the procedure.

Effect of Virtual Reality compared to Guided Visualization on Arteriovenous Fistula Cannulation pain and pain anxiety among hemodialysis children

Abstract Background: Children undergoing treatment with hemodialysis are exposed frequently to pain and anxiety which are caused by the insertion of large-gauge needles into an arteriovenous fistula. Non pharmacological pain management methods such as virtual reality and guided visualization are used to manage pain and pain related anxiety. Aim: to evaluate the effect of virtual reality compared to guided visualization on arteriovenous fistula cannulation pain and pain anxiety among hemodialysis children. Setting: the study was carried out at the Tanta Main University Hospital, Pediatric Medical Department, Dialysis Unit, Tanta City, Egypt. Sample: a convenience sampling of thirty children undergoing hemodialysis with arteriovenous fistula were included from the previously mentioned setting. Tools: there were three tools used: Tool I: Structured interview schedule, consisting of three components: sociodemographic characteristics of the children, data about the caregiver of the child and data related to the disease and fistula. Tool II: Wong–Baker faces pain rating scale for children. Tool III: Pain Anxiety Symptom Scale Short Form which was developed by McCracken (2002). Results: 53.33% and 33.33% of the studied children had moderate and severe pain anxiety symptoms pre-intervention respectively while 73.33%and 46.67%of them had mild pain anxiety symptoms during application of virtual reality and guided visualization respectively. Conclusion: visual reality was the preferred method which given the greater relief of pain and pain anxiety than guided visualization. Recommendations: visual reality should be used and disseminated to other hemodialysis centers as a strategy to reduce pain and pain anxiety among those children undergoing hemodialysis.

Effects of preoperative anxiety levels and the D-type personality on propolol injection pain.

Objective:Propofol injection pain (PIP) is a common condition in anesthesia practice and can be detrimental for patients. In this study, we aimed to investigate the effects of preoperative anxiety, depression levels, and D-type personality trait on PIP and to determine predictive factors.Methods:Sixty-eight patients who underwent elective septorhinoplasty under general anesthesia were analyzed. The effects of various factors (preoperative anxiety, depression, D-type personality, venous cannulation pain, gender, and age) on the incidence of PIP were assessed. To identify risk factors associated with PIP, multivariate logistic regression analysis was performed.Results:The incidence of PIP was significantly higher in patients who had preoperative anxiety and venous cannulation pain and who are Type D personality and female. Preoperative anxiety (β, 2.914; p=<0.001), Type D personality (β, 2.225; p=0.022) and venous cannulation pain (β, 1.590; p=0.043) were identified as independent risk factors for development of PIP. Depression, general anesthesia history, marital status, smoking, education status, and age were not significant as risk factors for the PIP.Conclusion:In addition to the physical factors that can predict PIP in anesthesia application, we believe that the presence of preoperative anxiety, Type D personality, and venous cannulation pain is significant, and it will be useful to apply preventive treatments for injection pain.

Comparison of the Effects of Visual and Auditory Distractions on Fistula Cannulation Pain among Older Patients Undergoing Hemodialysis: A Randomized Controlled Clinical Trial.

Pain associated with fistula cannulation is a challenge for nurses who provide care to older patients undergoing hemodialysis. Several non-pharmacological methods have been suggested for relieving fistula cannulation pain, but the benefits of visual and auditory distraction methods among older patients undergoing hemodialysis have not been investigated yet. Therefore, this study aimed to compare the effects of visual and auditory distractions on fistula cannulation pain among older patients undergoing hemodialysis. This randomized controlled clinical trial was conducted on 120 older patients undergoing hemodialysis. They were randomly assigned to three groups of visual distraction, auditory distraction, and the control (n = 40 in each group) using a simple random assignment method. The distraction interventions continued for three consecutive sessions and the numeric rating scale of pain severity was used for data collection. Descriptive and inferential statistics were used for data analysis using SPSS. It was found that pain severity significantly reduced after the distraction interventions in either the auditory or visual distraction groups and also after all three distraction sessions (p = 0.001). However, visual distraction had a better effect on the reduction of pain severity. Therefore, while both visual and auditory distractions reduced pain severity in older patients undergoing hemodialysis, visual distraction was more effective. Nurses are encouraged to incorporate visual distraction as a safe and non-pharmacologic technique into routine nursing care for reducing older patients’ suffering and improving their wellbeing when fistula cannulation is performed.

EFFECTIVENESS OF MUSIC PLAYBACK ON INTRAVENOUS CANNULATION PAIN AMONG CHILDREN

A quasi experimental study was conducted to assess the effectiveness of music playback on intravenous cannulation pain among children in a selected hospital. Objectives: to assess the mean posttest pain score among children in the experimental and control group, to find out the effectiveness of music playback on intravenous cannulation pain among children and to find out the association between posttest pain score and selected socio demo graphic variables of children in control group. Quasi experimental posttest only controls group design and convenience sampling technique was used to select 60 children in a selected hospital at Alappuzha district. Conceptual framework: Ernestine Wiedenbach’s Helping Art of Clinical Nursing Theory (1969). Posttest was conducted in the control and the experimental group by using FLACC Behavioral Pain Scale and Socio demographic proforma. Music playback was played to the experimental group for 10 minutes during intravenous cannulation. The data were tabulated and analysed using descriptive and inferential statistics. The mean posttest pain score of children in the experimental group was 4.1 with SD 1.33 which was significantly lower than the mean posttest pain score of children in the control group which was 7.8 with SD 1.27 with a mean difference of 3.6. The calculated ‘t’ value 10.910 was greater than the table value 2.00, is significant at p&lt;0.05 level with degree of freedom 58. Hence, we can conclude that the music playback was effective in reducing the pain level of children during intravenous cannulation. The analysis showed that the calculated chi square value for family monthly income, number of previous hospitalisations, previous exposure of cannulation were greater than that of the table value at p &lt; 0.05 level of significance. Hence null hypothesis (H02) can be rejected and research hypothesis (H2) can be accepted. So, it can be concluded that there was significant association between posttest pain score an

P1453THE DEVELOPMENT OF A NEW PATIENT-REPORTED OUTCOME MEASURE TO EVALUATE THE QUALITY OF DIALYSIS THERAPY

Abstract Background and Aims There is a growing interest in Patient-Reported Outcome Measures (PROMs) as evaluation tools of medical care globally, including dialysis therapy. We developed our original PROM for patients undergoing maintenance hemodialysis (MHD), which was named the Ai-POD (Ai means love in Japanese, POD stands for Patients Oriented Dialysis). The Ai-POD is composed of 20 items relating to physical symptoms (joint pain, itching, frustration, weakness, shortness of breath, constipation, difficulty getting to sleep, asleep condition), complaints during dialysis therapy (pain of cannulation, headache, drop of blood-pressure, leg crumps, fatigue after dialysis session), dietary conditions (appetite, food enjoyment, sore or dry mouth), mental health (depressive feeling, life enjoyment) and comprehensive life satisfaction. All items are rated on a Likert scale from 0 (best) to 4 (worst) except mental health. The mental health questions are yes-no closed questions converting 0 (excellent) or 4 (bad). The sum of all 20 components ranges from 0 to 80, denoting increasing of severity. We have been collecting the data of Ai -POD from all patients in our facilities for over ten years. We examined the associations between the score of Ai-POD and prospective mortality in our patients undergoing hemodialysis therapy to assess the usefulness of the Ai-POD score. Method Three hundred ninety-six patients (262 men, 134 women; age 66 ± 12years) on MHD therapy for at least three months were evaluated with Ai-POD in October 2013 and followed up for three years. We categorized the patients into the four groups according to the quartile of the Ai-POD score and compared anthropometric measurements and laboratory measurements among the groups. The four groups are as below: Grop1 (Score: 0 ∼ 10), Group 2 (11 ∼18), Group 3 (19 ∼29), and Group 4 (29 ∼). A Cox regression analysis was used to evaluate the association between the severity of the Ai-POD score and mortality risk adjusting with several factors. Kaplan-Meire analysis and Log-rank test assessed the mortality rate for comparison among the four groups. Results The average of Ai-POD score of all patients was 19.6 ± 11.7, following a normal distribution. Among the four quartile groups, we found no differences in age, dialysis vintage and diabetes ratio, but found the statistic difference in gender ratio and serum-albumin. Compared with Group 1, the multivariable-adjusted hazard ratio for mortality was significantly increased to 2.51 (95% CI 1.03 – 7.02) and 3.00 (95% CI 1.25 – 8.46) in Group 3 and Group 4, respectively. Kaplan-Meier analysis showed higher mortality in Group 3 and 4 (16.7% and 19.1% respectively) compared with Group 1 and 2 (5.6% and 6.5% respectively) significantly (p=0.0033) (Figure). Sub-analysis with each Ai-POD item indicated that frustration, appetite, food enjoyment, and overall life satisfaction were strong independent predictors of prognosis. Conclusion The score of PROM is a significant prognostic factor, suggesting the Ai-POD score could be one of the useful tools to estimate the quality of dialysis therapy. The strategies to improve the score in each item could enhance the quality of dialysis therapy.

P1328EFFECTIVENESS OF MUSIC FOR ALLEVIATING PAIN DURING HAEMODIALYSIS ACCESS CANNULATION: A MULTI-FACILITY, SINGLE-BLIND, RANDOMISED CONTROLLED TRIAL

Abstract Background and Aims Repeated needle pain during haemodialysis (HD) access cannulations is a serious problem for HD patients. Although the efficacy of music for alleviating pain and anxiety is well established, there is insufficient scientific evidence related to its effectiveness in alleviating pain during access cannulations during HD. This study aimed to investigate the effects of music on reducing pain during access cannulating in HD patients. Method A prospective, multi-facility, single-blind, crossover, randomised controlled trial was conducted. The intervention included listening to Mozart and a white-noise control condition. Patients were randomly allocated to either an ‘Early-group’ or a ‘Later-group’. All patients who underwent cannulation wore headphones without sound in the first and third weeks (No-sound period). The Early-group received cannulation while listening to Mozart’s Sonata for Two Pianos in D major (K.448) during the second week (Music period), and white noise during the fourth week (White noise period). The Later-group received cannulation while listening to white noise first, followed by Mozart in the fourth week. During each period, the music or no-music protocol started 8 minutes prior to the cannulation, and participants finished listening after HD began. The Visual Analogue Scale (VAS) was used to measure pain and anxiety during cannulation and the VAS scores for pain and anxiety were compared for the music and no-music settings. We evaluated the ratio of outcome measures between the music and white noise periods with the repeated measure mixed effect regression. We analysed the effects according to the intention-to-treat principle. Two-sided-significance-level was set at 0.05. Results In total, one hundred and twenty-one patients were enrolled in this study, across four facilities. The median age was 64 years, and there were 84 males (69.4%). Sixty-five patients (53.7%) used analgesics for alleviating pain. The median VAS pain score was 28 and VAS anxiety score was 19 in No-sound period. The Mozart music setting had a 12.2% (95% confidence interval (CI): 2.3 to 21.1, p=0.017) lower VAS score than the white noise setting. On the other hand, there was no significant difference in the VAS anxiety score between the two groups, that is the Mozart music setting had a 7.96% (95% CI: -4.70 to 18.4, p=0.172) reduction compared to the white noise setting. Conclusion We examined the effects of Mozart’s music on alleviating pain using scientific methods. The music appears to reduce pain of access cannulation in HD patients. Although the trial assessed the effects of music using a single musical composition, the study did not clarify the effects of music on the physical, emotional, and cognitive status of patients. Further studies in this direction are required.