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Interventions to Reduce Pain During Arteriovenous Fistula Cannulation in Hemodialysis Patients

Year 2025, Volume: 20 Issue: 3, 191 - 203, 30.09.2025
https://doi.org/10.47565/ndthdt.2025.111

Abstract

Patients undergoing hemodialysis often experience pain due to arteriovenous fistula cannulation. Alleviating this pain may improve patients’ psychological well-being, adherence to treatment, satisfaction, and overall quality of life. This literature review aims to present the methods used to reduce arteriovenous fistula cannulation-related pain and provide recommendations on the topic. This study was conducted as a literature review between March 1 and March 20, 2025. The literature search was performed using the following databases: Embase, EBSCO, CINAHL, Cochrane, Medline/PubMed, ScienceDirect, Ulakbim, DergiPark, and Google Scholar. The keywords used were “hemodialysis,” “arteriovenous fistula cannulation,” and “pain” in the international literature, and “hemodiyaliz,” “arteriyovenöz fistül kanülasyonu,” and “ağrı” in the national literature. As a result of the screening, 244 studies were identified, and the study was completed by reviewing 14 articles thatmet the inclusion criteria. The PRISMA statement was used in the development of the protocol and the writing of the article. The methodological quality assessment of the included articles was conducted using the checklists developed by the Joanna Briggs Institute. This literature review found that pain experienced by patients during arteriovenous fistula cannulation in ongoing
hemodialysis treatment can be reduced through the use of topical anesthetic agents, topical cold applications, sprays with cooling effects, distraction techniques (e.g., watching films, audiovisual stimuli, use of stress balls), and the application of lavender oil either topically or via inhalation.

References

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  • 2. Dinis M, Sousa J. A pilot randomised controlled trial on the effectiveness of an anti-stress ball technique for pain reduction during vascular access cannulation in haemodialysis patients. Nurs Reports. 2023;13(2):731-9. https://doi.org/10.3390/nursrep13020064
  • 3. Bello A, Okpechi I, Osman M, Cho Y, Htay H, Jha V, vd. Epidemiology of haemodialysis outcomes. Nat Rev Nephrol. 2022;18(6):378-95. https://doi.org/10.1038/s41581-022-00542-7
  • 4. Aghbolagh M, Bahrami T, Rejeh N, Heravi-Karimooi M, Tadrisi S, Vaismoradi M. Comparison of the effects of visual and auditory distractions on fistula cannulation pain among older patients undergoing hemodialysis: A randomized controlled clinical trial. Geriatrics. 2020;5(3):53. https://doi.org/10.3390/geriatrics5030053
  • 5. Stegmayr B, Willems C, Groth T, Martins A, Neves N, Mottaghy K, et al. Arteriovenous access in hemodialysis: A multidisciplinary perspective for future solutions. Int J Artif Organs. 2021;44(1):3-16. https://doi.org/10.1177/0391398820922231
  • 6. Kosmadakis G, Amara I, Costel G. Pain on arteriovenous fistula cannulation: A narrative review. Semin Dial. 2021;34(4):275-84. https://doi.org/10.1111/sdi.12979
  • 7. Duncanson E, Le Leu R, Shanahan L, Macauley L, Bennett P. The prevalence and evidence-based management of needle fear in adults with chronic disease: A scoping review. Wieland LS, ed. PLoS One. 2021;16(6):e0253048. https://doi.org/10.1371/journal.pone.0253048
  • 8. Alzaatreh M, Abdalrahim M. Management strategies for pain associated with arteriovenous fistula cannulation: An integrative literature review. Hemodial Int. 2020;24(1):3-11. https://doi.org/10.1111/hdi.12803.
  • 9. Sadeghpour Marvi H, Baloochi Beydokhti T, Sajjadi M, Khaleghimanesh B. Comparing effects of rhythmic breathing and lidocaine spray on pain intensity during needle insertion into arteriovenous fistula in hemodialysis patients: A randomized controlled trial. Anesthesiol Pain Med. 2023;13(2):E126384. https://doi.org/10.5812/aapm-126384
  • 10. Arshad A, Ijaz U, Rafique B. Pharmacological interventions for pain management during arteriovenous fistula puncture in adults and adolescents undergoing maintenance haemodialysis: A systematic review. Ren Replace Ther. 2024;10(1):46. https://doi.org/10.1186/s41100-24-00562-y
  • 11. Karaçam Z. Sistematik derleme metodolojisi: sistematik derleme hazırlamak için bir rehber. DEUHYO ED [Internet]. 2013[cited 2025 May 30];6(1):26-33. Available from: https://dergipark.org.tr/tr/pub/deuhfed/issue/46815/587078
  • 12. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097
  • 13. jbi.global [Internet]. Joanna Briggs Institute. Critical appraisal tools for use in JBI systematic reviews. Adelaide: The University of Adelaide. 2017[cited 2025 May 25]. Available from: https://jbi.global/critical-appraisal-tools
  • 14. Çelik G, Özbek O, Yılmaz M, Duman I, Özbek S, Apiliogullari S. Vapocoolant spray vs lidocaine/prilocaine cream for reducing the pain of venipuncture in hemodialysis patients: A randomized, placebo-controlled, crossover study. Int J Med Sci. 2011;8(7):623-7. doi:10.7150/ijms.8.623
  • 15. Ghoreyshi Z, Amerian M, Amanpour F, Ebrahimi H. Evaluation and comparison of the effects of Xyla-P cream and cold compress on the pain caused by the cannulation of arteriovenous fistula in hemodialysis patients. Saudi J Kidney Dis Transplant. 2018;29(2):369. doi: 10.4103/1319-2442.229265
  • 16. Babamohamadi H, Ameri Z, Asadi I, Asgari M. Comparison of the effect of Emlatm cream and the valsalva maneuver on pain severity during vascular needle ınsertion in hemodialysis patients: A controlled, randomized, clinical trial. Sandner Kiesling A, ed. Evidence- Based Complement Altern Med. 2022;2022:1-9. https://doi.org/10.1155/2022/8383021
  • 17. Gouda K, EL said T, Fahmy S. The effect of cold packs, lidocaine spray, and flashlights on cannulation pain in patients undergoing hemodialysis: A randomized controlled trial. Futur J Pharm Sci. 2023;9(1):100. https://doi.org/10.1186/s43094-023-00539-4
  • 18. Al Shahri H, Al Salmi I, Al Rajhi W, Shemshaki H. Effectiveness of the eutectic mixture of local anaesthetics cream in the management of arteriovenous fistula needle ınsertion pain in patients undergoing haemodialysis. Sultan Qaboos Univ Med J. 2024;24(1):7-19. https://doi. org/10.18295/squmj.10.2023.058
  • 19. Aghajanloo A, Ghafourifard M, Haririan H, Gheydari P. Comparison of the effects of cryotherapy and placebo on reducing the pain of arteriovenous fistula cannulation among hemodialysis patients: A randomized control trial. J Nurs Midwifery Sci. 2016;3(1):59. https://doi.org/10.18869/acadpub.jnms.3.1.59
  • 20. Maghbool M, Khosravi T, Vojdani S, Chaijan M, Esmaeili F. The effects of eugenol nanoemulsion on pain caused by arteriovenous fistula cannulation in hemodialysis patients: A randomized double-blinded controlled cross-over trial. Complement Ther Med. 2020;52:102440. https://doi.org/10.1016/j.ctim.2020.102440
  • 21. Sasani A, Rahzani K, Hekmatpou D, Haghverdi F. Comparing the effect of cryotherapy on hugo point and needle ınsertion site on the pain of arteriovenous fistula cannulation in patient with hemodialysis. J Clin Care Ski. 2024;5(2):85-91. doi: 10.58209/jccs.5.2.85
  • 22. Şen H, Lafcı Bakar D. The effect of virtual reality glasses on pain and patient satisfaction in arteriovenous fistula cannulation procedure. Appl Nurs Res. 2024;79:151841. https://doi.org/10.1016/j.apnr.2024.151841
  • 23. Tüzün Özdemir S, Akyol A. Effect of inhaler and topical lavender oil on pain management of arteriovenous fistula cannulation. J Vasc Access. 2023;24(3):465-74. https://doi.org/10.1177/11297298211031086.
  • 24. Kim H, An J, Lee Y, Shin Y. The effects of cryotherapy on perineal pain after childbirth: A systematic review and meta-analysis. Midwifery. 2020;89:102788. https://doi.org/10.1016/j.midw.2020.102788
  • 25. Krampe P, Bendo A, Barros M, Bertolini G, Buzanello Azevedo M. Cryotherapy in knee arthroplasty: Systematic review and meta-analy-sis. Ther hypothermia temp manag. 2023;13(2):45-54. https://doi.org/10.1089/ther.2022.0043
  • 26. Lee Y, Shin Y, Kim H, An J. Effectiveness and methods of cryotherapy in reducing swelling after total knee arthroplasty: A systematic review on randomized controlled trials. Nurs Open. 2023;10(9):5989-98. https://doi.org/10.1002/nop2.1906.
  • 27. Muaddi H, Lillie E, Silva S, Cross J, Ladha K, Choi S, vd. The effect of cryotherapy application on postoperative pain: A systematic review and meta-analysis. Ann Surg. 2023;277(2):e257-65. doi: 10.1097/SLA.00000000000004987
  • 28. Ghadimi M, Rejeh N, Heravi-Karimooi M, Tadrisi S. The effect of audio distraction technique on the intensity of pain caused by the insertion of dialysis needles in hemodialysis elderly patients. Iran J Nurs Res. 2019;13(6). doi: 10.21859/ijnr-130601
  • 29. Alan N, Khorshid L. Evaluation of efficacy of valsalva maneuver during peripheral ıntravenous cannulation on pain. Pain Manag Nurs. 2022;23(2):220-4. https://doi.org/10.1016/j.pmn.2021.01.013
  • 30. Hosseini S, Mohammadpour A, Mojtabavi S, Baloochi Beydokhti T. Comparison Valsalva maneuver and auriculotherapy on pain intensity of peripheral intravenous cannulation in adults: A randomized clinical trial. J Vasc Access. 2025. https://doi.org/10.1177/11297298251314217.
  • 31. Pratiwi A. The Implementation of Valsava Manuever on Pain Reduction During IV Cannulation: A literature review. JIKO (Jurnal Ilm Keperawatan Orthop. 2023;7(2):69-76. doi:10.46749/jiko.v7i2.136
  • 32. Saputra M, Harahap I, Kasiman S. Valsalva Maneuver to Decrease Pain Intensity During Arteriovenous Fistula Insertion in Hemodialysis Patients. J Keperawatan Indones. 2020;23(2):136-44 doi:10.7454/jki.v23i2.645
  • 33. Toraman R, Eskici Ilgin V. Effect of virtual reality glasses application on pain, anxiety, and patient satisfaction during a transrectal prostate biopsy: A randomized controlled trial. Biol Res Nurs. 024;26(4):485-97. https://doi.org/10.1177/10998004241236154
  • 34. Basak T, Demirtas A, Yorubulut S. Virtual reality and distraction cards to reduce pain during intramuscular benzathine penicillin injection procedure in adults: A randomized controlled trial. J Adv Nurs. 2021;77(5):2511-8.https://doi.org/10.1111/jan.14782
  • 35. 35. Groninger H, Violanti D, Mete M. Virtual reality for pain management in hospitalized patients with cancer: A randomized controlled trial. Cancer. 2024;130(14):2552-60. https://doi.org/10.1002/cncr.35282
  • 36. Bülbül F, Özdemir S. The comparative effects of ball squeezing and cartoon watching in pain management in children during intramuscular injection: A randomized control trial. Mehmet Akif Ersoy Univ J Health Sci Inst. 2022;10(3):134-45. https://doi.org/10.24998/maeusabed. 1123566.
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Hemodiyaliz Hastalarında Arteriovenöz Fistül Kanülasyonuna Bağlı Ağrının Azaltılmasına Yönelik Müdahaleler/Interventions to Reduce Pain During Arteriovenous Fistula Cannulation in Hemodialysis Patients

Year 2025, Volume: 20 Issue: 3, 191 - 203, 30.09.2025
https://doi.org/10.47565/ndthdt.2025.111

Abstract

Hemodiyaliz hastaları, arteriyovenöz fistül kanülasyonuna bağlı olarak sıklıkla ağrı yaşamaktadır. Bu ağrının giderilmesi, hastaların psikolojik açıdan daha iyi hissetmelerini, tedaviye uyumlarını, memnuniyetlerini ve yaşam kalitelerini artırabilir. Bu literatür incelemesi ile arteriyovenöz fistül kanülasyonuna bağlı ağrıyı azaltmaya yönelik kullanılan yöntemlerin ve bu konudaki önerilerin topluca sunulması amaçlanmaktadır. Bu çalışma, bir literatür incelemesi olarak 1-20 Mart 2025 tarihleri arasında gerçekleştirilmiştir. Tarama işlemleri; Embase, EBSCO, CINAHL, Cochrane, Medline/PubMed, ScienceDirect, Ulakbim, DergiPark ve Google Akademik veri tabanlarında yapılmıştır. Uluslararası literatür taramalarında “hemodialysis”, “arteriovenous fistula cannulation” ve “pain” terimleri; ulusal literatürde ise “hemodiyaliz”, “arteriyovenöz fistül kanülasyonu” ve “ağrı” anahtar kelimeleri kullanılmıştır. Tarama sonucunda 244 çalışmaya ulaşılmış, dahil edilme kriterlerini karşılayan 14 makale incelenerek çalışma tamamlanmıştır.Protokolün oluşturulması ve makalenin yazımında PRISMA bildirimi esas alınmıştır. Dâhil edilen makalelerin metadolojik kalite değerlendirmesi “Joanna Briggs Institute” tarafından geliştirilen kontrol listeleriyle gerçekleştirilmiştir. Literatür incelemesi sonucunda, hemodiyaliz tedavisi süren hastaların arteriyovenöz fistül
kanülasyonu sırasında yaşadığı ağrının; topikal anestezik ajanlar, topikal soğuk uygulamalar, soğuk spreyler, dikkat dağıtıcı yöntemler (film izleme, görsel-işitsel uyaranlar, stres topu kullanımı vb.) ve lavanta yağının topikal ya da inhalasyon yoluyla uygulanması gibi yöntemlerle azaltılabildiği bulunmuştur.

References

  • 1. Naber T, Purohit S. Chronic kidney disease: Role of diet for a reduction in the severity of the disease. Nutrients. 2021;13(9):3277. https://doi.org/10.3390/nu13093277
  • 2. Dinis M, Sousa J. A pilot randomised controlled trial on the effectiveness of an anti-stress ball technique for pain reduction during vascular access cannulation in haemodialysis patients. Nurs Reports. 2023;13(2):731-9. https://doi.org/10.3390/nursrep13020064
  • 3. Bello A, Okpechi I, Osman M, Cho Y, Htay H, Jha V, vd. Epidemiology of haemodialysis outcomes. Nat Rev Nephrol. 2022;18(6):378-95. https://doi.org/10.1038/s41581-022-00542-7
  • 4. Aghbolagh M, Bahrami T, Rejeh N, Heravi-Karimooi M, Tadrisi S, Vaismoradi M. Comparison of the effects of visual and auditory distractions on fistula cannulation pain among older patients undergoing hemodialysis: A randomized controlled clinical trial. Geriatrics. 2020;5(3):53. https://doi.org/10.3390/geriatrics5030053
  • 5. Stegmayr B, Willems C, Groth T, Martins A, Neves N, Mottaghy K, et al. Arteriovenous access in hemodialysis: A multidisciplinary perspective for future solutions. Int J Artif Organs. 2021;44(1):3-16. https://doi.org/10.1177/0391398820922231
  • 6. Kosmadakis G, Amara I, Costel G. Pain on arteriovenous fistula cannulation: A narrative review. Semin Dial. 2021;34(4):275-84. https://doi.org/10.1111/sdi.12979
  • 7. Duncanson E, Le Leu R, Shanahan L, Macauley L, Bennett P. The prevalence and evidence-based management of needle fear in adults with chronic disease: A scoping review. Wieland LS, ed. PLoS One. 2021;16(6):e0253048. https://doi.org/10.1371/journal.pone.0253048
  • 8. Alzaatreh M, Abdalrahim M. Management strategies for pain associated with arteriovenous fistula cannulation: An integrative literature review. Hemodial Int. 2020;24(1):3-11. https://doi.org/10.1111/hdi.12803.
  • 9. Sadeghpour Marvi H, Baloochi Beydokhti T, Sajjadi M, Khaleghimanesh B. Comparing effects of rhythmic breathing and lidocaine spray on pain intensity during needle insertion into arteriovenous fistula in hemodialysis patients: A randomized controlled trial. Anesthesiol Pain Med. 2023;13(2):E126384. https://doi.org/10.5812/aapm-126384
  • 10. Arshad A, Ijaz U, Rafique B. Pharmacological interventions for pain management during arteriovenous fistula puncture in adults and adolescents undergoing maintenance haemodialysis: A systematic review. Ren Replace Ther. 2024;10(1):46. https://doi.org/10.1186/s41100-24-00562-y
  • 11. Karaçam Z. Sistematik derleme metodolojisi: sistematik derleme hazırlamak için bir rehber. DEUHYO ED [Internet]. 2013[cited 2025 May 30];6(1):26-33. Available from: https://dergipark.org.tr/tr/pub/deuhfed/issue/46815/587078
  • 12. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097
  • 13. jbi.global [Internet]. Joanna Briggs Institute. Critical appraisal tools for use in JBI systematic reviews. Adelaide: The University of Adelaide. 2017[cited 2025 May 25]. Available from: https://jbi.global/critical-appraisal-tools
  • 14. Çelik G, Özbek O, Yılmaz M, Duman I, Özbek S, Apiliogullari S. Vapocoolant spray vs lidocaine/prilocaine cream for reducing the pain of venipuncture in hemodialysis patients: A randomized, placebo-controlled, crossover study. Int J Med Sci. 2011;8(7):623-7. doi:10.7150/ijms.8.623
  • 15. Ghoreyshi Z, Amerian M, Amanpour F, Ebrahimi H. Evaluation and comparison of the effects of Xyla-P cream and cold compress on the pain caused by the cannulation of arteriovenous fistula in hemodialysis patients. Saudi J Kidney Dis Transplant. 2018;29(2):369. doi: 10.4103/1319-2442.229265
  • 16. Babamohamadi H, Ameri Z, Asadi I, Asgari M. Comparison of the effect of Emlatm cream and the valsalva maneuver on pain severity during vascular needle ınsertion in hemodialysis patients: A controlled, randomized, clinical trial. Sandner Kiesling A, ed. Evidence- Based Complement Altern Med. 2022;2022:1-9. https://doi.org/10.1155/2022/8383021
  • 17. Gouda K, EL said T, Fahmy S. The effect of cold packs, lidocaine spray, and flashlights on cannulation pain in patients undergoing hemodialysis: A randomized controlled trial. Futur J Pharm Sci. 2023;9(1):100. https://doi.org/10.1186/s43094-023-00539-4
  • 18. Al Shahri H, Al Salmi I, Al Rajhi W, Shemshaki H. Effectiveness of the eutectic mixture of local anaesthetics cream in the management of arteriovenous fistula needle ınsertion pain in patients undergoing haemodialysis. Sultan Qaboos Univ Med J. 2024;24(1):7-19. https://doi. org/10.18295/squmj.10.2023.058
  • 19. Aghajanloo A, Ghafourifard M, Haririan H, Gheydari P. Comparison of the effects of cryotherapy and placebo on reducing the pain of arteriovenous fistula cannulation among hemodialysis patients: A randomized control trial. J Nurs Midwifery Sci. 2016;3(1):59. https://doi.org/10.18869/acadpub.jnms.3.1.59
  • 20. Maghbool M, Khosravi T, Vojdani S, Chaijan M, Esmaeili F. The effects of eugenol nanoemulsion on pain caused by arteriovenous fistula cannulation in hemodialysis patients: A randomized double-blinded controlled cross-over trial. Complement Ther Med. 2020;52:102440. https://doi.org/10.1016/j.ctim.2020.102440
  • 21. Sasani A, Rahzani K, Hekmatpou D, Haghverdi F. Comparing the effect of cryotherapy on hugo point and needle ınsertion site on the pain of arteriovenous fistula cannulation in patient with hemodialysis. J Clin Care Ski. 2024;5(2):85-91. doi: 10.58209/jccs.5.2.85
  • 22. Şen H, Lafcı Bakar D. The effect of virtual reality glasses on pain and patient satisfaction in arteriovenous fistula cannulation procedure. Appl Nurs Res. 2024;79:151841. https://doi.org/10.1016/j.apnr.2024.151841
  • 23. Tüzün Özdemir S, Akyol A. Effect of inhaler and topical lavender oil on pain management of arteriovenous fistula cannulation. J Vasc Access. 2023;24(3):465-74. https://doi.org/10.1177/11297298211031086.
  • 24. Kim H, An J, Lee Y, Shin Y. The effects of cryotherapy on perineal pain after childbirth: A systematic review and meta-analysis. Midwifery. 2020;89:102788. https://doi.org/10.1016/j.midw.2020.102788
  • 25. Krampe P, Bendo A, Barros M, Bertolini G, Buzanello Azevedo M. Cryotherapy in knee arthroplasty: Systematic review and meta-analy-sis. Ther hypothermia temp manag. 2023;13(2):45-54. https://doi.org/10.1089/ther.2022.0043
  • 26. Lee Y, Shin Y, Kim H, An J. Effectiveness and methods of cryotherapy in reducing swelling after total knee arthroplasty: A systematic review on randomized controlled trials. Nurs Open. 2023;10(9):5989-98. https://doi.org/10.1002/nop2.1906.
  • 27. Muaddi H, Lillie E, Silva S, Cross J, Ladha K, Choi S, vd. The effect of cryotherapy application on postoperative pain: A systematic review and meta-analysis. Ann Surg. 2023;277(2):e257-65. doi: 10.1097/SLA.00000000000004987
  • 28. Ghadimi M, Rejeh N, Heravi-Karimooi M, Tadrisi S. The effect of audio distraction technique on the intensity of pain caused by the insertion of dialysis needles in hemodialysis elderly patients. Iran J Nurs Res. 2019;13(6). doi: 10.21859/ijnr-130601
  • 29. Alan N, Khorshid L. Evaluation of efficacy of valsalva maneuver during peripheral ıntravenous cannulation on pain. Pain Manag Nurs. 2022;23(2):220-4. https://doi.org/10.1016/j.pmn.2021.01.013
  • 30. Hosseini S, Mohammadpour A, Mojtabavi S, Baloochi Beydokhti T. Comparison Valsalva maneuver and auriculotherapy on pain intensity of peripheral intravenous cannulation in adults: A randomized clinical trial. J Vasc Access. 2025. https://doi.org/10.1177/11297298251314217.
  • 31. Pratiwi A. The Implementation of Valsava Manuever on Pain Reduction During IV Cannulation: A literature review. JIKO (Jurnal Ilm Keperawatan Orthop. 2023;7(2):69-76. doi:10.46749/jiko.v7i2.136
  • 32. Saputra M, Harahap I, Kasiman S. Valsalva Maneuver to Decrease Pain Intensity During Arteriovenous Fistula Insertion in Hemodialysis Patients. J Keperawatan Indones. 2020;23(2):136-44 doi:10.7454/jki.v23i2.645
  • 33. Toraman R, Eskici Ilgin V. Effect of virtual reality glasses application on pain, anxiety, and patient satisfaction during a transrectal prostate biopsy: A randomized controlled trial. Biol Res Nurs. 024;26(4):485-97. https://doi.org/10.1177/10998004241236154
  • 34. Basak T, Demirtas A, Yorubulut S. Virtual reality and distraction cards to reduce pain during intramuscular benzathine penicillin injection procedure in adults: A randomized controlled trial. J Adv Nurs. 2021;77(5):2511-8.https://doi.org/10.1111/jan.14782
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There are 47 citations in total.

Details

Primary Language Turkish
Subjects ​Internal Diseases Nursing​, Nephrology Nursing
Journal Section Article
Authors

Ahmet Topcu 0000-0003-1398-9930

Rukiye Burucu 0000-0002-9284-5486

Publication Date September 30, 2025
Submission Date June 11, 2025
Acceptance Date September 25, 2025
Published in Issue Year 2025 Volume: 20 Issue: 3

Cite

Vancouver Topcu A, Burucu R. Hemodiyaliz Hastalarında Arteriovenöz Fistül Kanülasyonuna Bağlı Ağrının Azaltılmasına Yönelik Müdahaleler/Interventions to Reduce Pain During Arteriovenous Fistula Cannulation in Hemodialysis Patients. JoNN. 2025;20(3):191-203.

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