Music-Assisted Acupressure for Pain During AVF Cannulation in Hemodialysis Patients

This study was designed as a randomized controlled trial to investigate the effect of music-assisted acupressure on procedural pain during arteriovenous fistula (AVF) cannulation in patients undergoing hemodialysis. The study was conducted between March and November 2024 in the hemodialysis unit of a state hospital in Gaziantep, Türkiye.

A total of 72 eligible patients receiving hemodialysis treatment via AVF were included. Patients were randomly assigned into four equal groups (n=18 per group): music-assisted acupressure, acupressure, music, and control. Randomization was performed using a simple lottery method. All AVF cannulation procedures were performed by the same experienced dialysis nurse to ensure procedural consistency.

The acupressure intervention was applied to the Hegu (LI4) point on the hand contralateral to the AVF site. Finger pressure was applied perpendicularly for approximately 3 minutes prior to needle insertion. The music intervention consisted of listening to instrumental Classical Turkish Music in the Acemaşiran mode through headphones, beginning 5 minutes before cannulation and continuing until the end of the procedure.

Participants in the combined intervention group received both acupressure and music simultaneously using the same protocols described above. The control group received routine hemodialysis care without additional intervention.

Pain intensity during AVF cannulation was assessed using the Visual Analog Scale (VAS, 0-10) immediately after each procedure. Measurements were repeated over three consecutive hemodialysis sessions. Sociodemographic and clinical data were also collected using a structured patient information form.

The primary outcome of the study was pain intensity during AVF cannulation. Data were analyzed using non-parametric statistical tests due to non-normal distribution, including Kruskal-Wallis, Friedman, and Brunner-Langer models for repeated measures. Statistical significance was set at p < 0.05.

Inclusion criteria

• Age ≥ 18 years
• Receiving hemodialysis treatment three times per week
• Presence of an arteriovenous fistula (AVF) for vascular access
• Ability to communicate in Turkish
• No use of analgesic medication prior to AVF cannulation
• No pain or pathology in the upper extremities that could affect intervention application or pain assessment
• Willingness to participate in the study and provide informed consent

Exclusion criteria

• Diagnosis of neuropathy
• History of upper extremity surgery or soft tissue injury
• Presence of bleeding disorders or coagulation disorders
• Diagnosis of heart failure
• Presence of a pacemaker
• Inability to comply with study procedures or complete data collection
• Any condition that could interfere with pain perception or the application of acupressure or music intervention