DefinePK

Abstract

Background & Objective: An arteriovenous fistula (AVF) is required in hemodialysis for better blood flow going into the dialysis machine. Almost all of the patients feel pain and anxiety from needle insertion when undergoing every session of hemodialysis. We conducted this study to determine the effect of the Valsalva maneuver on pain and anxiety levels in patients during needle insertion in the arteriovenous fistula for hemodialysis.
Methodology: A quasi-experimental design was used in the study. This study was conducted on 120 patients undergoing hemodialysis from September 19, 2024, to May 10, 2025, at the hemodialysis center at Imam Al-Hussein Medical City and the hemodialysis unit of Imam Al-Hassan Al-Mujtaba Teaching Hospital in Kerbala, Iraq. The G*Power calculator was used to determine the total number of participants.13 The sample of the study was obtained using a non-probability purposive sampling technique. The patients in the study group were demonstrated the method how to perform the Valsalva maneuver. The breath-holding typically lasted between 10 to 20 seconds during the maneuver. The Visual Analog Scale (VAS) was used to measure pain and anxiety levels.
Results: A significant reduction in pain levels was noticed among hemodialysis patients who received the Valsalva maneuver compared to the control group. The study group exhibited a more favorable pain profile, with 38% reporting mild pain and 60% reporting moderate pain. In the study group, 60% of patients reported mild anxiety, and 36% reported moderate anxiety with a mean anxiety score of 3.28 ± 1.429.
Conclusion: The findings of this study confirm the significant impact of the Valsalva maneuver in reducing pain level and anxiety among patients during needle insertion in AVF to undergo hemodialysis.
Abbreviations: AVF: arteriovenous fistula, BMI: Body Mass Index, CKD: Chronic kidney disease, NPS: Numeric Pain Scale
Keywords: anxiety; arteriovenous fistula; hemodialysis; pain; Valsalva maneuver
Citation: Mahdi EH, Dawood HA. Effect of Valsalva maneuver on pain level and anxiety during needle insertion in arteriovenous fistula among patients undergoing hemodialysis. Anaesth. pain intensive care 2025;29(5):367-375. DOI: 10.35975/apic.v29i5.2841
Received: July 09, 2025; Revised: July 26, 2025; Accepted: July 27, 2025