Effectiveness of Cryotherapy on Arteriovenous Fistula Puncture Related Pain Among Hemodialysis Patients in Selected Hospitals, Mangalore

AIM: The purpose of the study is to assess the effectiveness of cryotherapy during arteriovenous fistula puncture related pain among hemodialysis patients. BACKGROUND: Hemodialysis is one of the most frequently used modality for renal replacement therapy. Pain inflicted by the insertion of large cannulae into the arteriovenous fistula is a significant cause of concern for both the children and adults on regular hemodialysis. Cryotherapy as a non pharmacological pain management is a complimentary therapy has the advantage of being effective, less cost, easy to provide and safe.

The study consist of total 50 samples, 25 in experimental group and 25 in control group

DESIGN: The design adopted for the study was Quasi experimental time series design. Using the purposive sampling technique, 50 (experimental=25, control=25) chronic renal failure patients were selected and data was collected using the demographic proforma, numerical rating scale and observational checklist for behavioral response during arteriovenous fistula puncture. On next cycle after 1st assessment of arteriovenous puncture related pain, cryotherapy was given to the experimental group with ice pack on the web between the thumb and index finger of the hand not having the arteriovenous fistula (contralateral arm). The procedure was started 5 minutes before venepuncture and continued throughout the puncturing procedure approximately 10 minute. Pain and behavioral response to pain was assessed in both the control and experimental group using the numerical rating scale and observational checklist during arteriovenous fistula puncture. On next cycle of hemodialysis same procedure was repeated among the experimental group and pain and behavioral response to pain was assessed in both the experimental and control group.

RESULTS: There was a significant difference between the pre-test and post- test behavioral response scores and pain scores in the experimental group (F2,72= 3.15, p<0.05). The mean post-test behavioral response scores of the experimental group (3.2±1.05, 2.8±1.11) was lower than the mean post-test behavioral response scores of the control group (4.6±1.22, 4.5±0.86) in the post-test 1 , 2 respectively. The calculated 't' values (t1=4.21, t2=6.21) were more than the table value (t48=1.96) at 0.05 level of significance. The mean post-test pain scores of the experimental group (3.3±1.37, 2.8±1.09) were lower than the mean post- test pain scores of the control group (4.32±0.9, 4.56±1) in the post-test 1, 2 respectively. The calculated 't' values (t1=3.04, t2=5.66) were more than the table value (t48=1.96) at 0.05 level of significance. CONCLUSION: The findings of the study concluded that cryotherapy was effective in reducing subjective pain and objective behavioral response scores of arteriovenous fistula puncture related pain.