This pilot randomized controlled trial evaluated a multicomponent intervention for adult maintenance hemodialysis patients with difficult vascular access cannulation. Participants were randomly assigned to an intervention group or a usual-care control group. The intervention included pre-cannulation ultrasound vascular mapping, handgrip exercise, and local cryotherapy before vascular access cannulation. The study assessed visual analog scale pain, first-attempt cannulation success, perceived pain, anxiety, comfort, and overall care satisfaction. Participants in the intervention group also evaluated the acceptability of the intervention.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
69
Pre-cannulation ultrasound vascular mapping was performed before vascular access cannulation to assess vessel course, depth, blood flow, and suitable cannulation areas. The vascular map was provided as a reference for the cannulating nurse when selecting the cannulation site. Routine visual inspection and palpation were also performed before cannulation.
Participants performed handgrip exercise before vascular access cannulation as part of the multicomponent intervention.
Local cryotherapy was applied before vascular access cannulation as part of the multicomponent intervention.
Participants in the control group received usual care, including routine visual inspection and palpation of the vascular access before cannulation. They did not receive pre-cannulation ultrasound vascular mapping, handgrip exercise, or local cryotherapy.
Kaohsiung Chang Gung Memorial Hospital
Kaohsiung City, Taiwan
VAS Pain Score
Pain intensity was assessed using a 0-10 visual analog scale (VAS), with higher scores indicating greater pain. VAS pain was measured before vascular access cannulation and immediately after completion of arterial and venous needle insertion.
Time frame: Before cannulation and immediately after completion of arterial and venous needle insertion on the same hemodialysis session.
First-Attempt Cannulation Success
First-attempt cannulation success was defined as successful placement of both arterial and venous needles on the first attempt. If either needle required repeat cannulation and the total number of needle insertions exceeded two, the cannulation was classified as unsuccessful on the first attempt.
Time frame: During vascular access cannulation in the same hemodialysis session.
Pain Perception Score
Pain perception was assessed using a 5-item questionnaire. Each item was rated on a 4-point Likert scale, with a total score ranging from 5 to 20. Higher scores indicated greater pain perception. The scale was administered before vascular access cannulation and immediately after completion of arterial and venous needle insertion.
Time frame: Before cannulation and immediately after completion of arterial and venous needle insertion in the same hemodialysis session.
Anxiety Perception Score
Anxiety perception was assessed using a 5-item questionnaire. Each item was rated on a 4-point Likert scale, with a total score ranging from 5 to 20. Higher scores indicated greater anxiety perception. The scale was administered before vascular access cannulation and immediately after completion of arterial and venous needle insertion.
Time frame: Before cannulation and immediately after completion of arterial and venous needle insertion in the same hemodialysis session.
Comfort Score
Comfort was assessed using a 4-item questionnaire. Each item was rated on a 4-point Likert scale, with a total score ranging from 4 to 16. Higher scores indicated greater comfort. The scale was administered before vascular access cannulation and immediately after completion of arterial and venous needle insertion.
Time frame: Before cannulation and immediately after completion of arterial and venous needle insertion in the same hemodialysis session.
Overall Care Satisfaction Score
Overall care satisfaction was assessed using a 6-item questionnaire. Each item was rated on a 4-point Likert scale, with a total score ranging from 6 to 24. Higher scores indicated greater satisfaction with overall care. The scale was administered before vascular access cannulation and immediately after completion of arterial and venous needle insertion.
Time frame: Before cannulation and immediately after completion of arterial and venous needle insertion in the same hemodialysis session.
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