Comparative Effectiveness of Vapocoolant Spray, Hugo Point Acupressure, and Rhythmic Breathing for Pain Reduction During Arteriovenous Fistula Cannulation in Hemodialysis

Objective: To compare the effectiveness of three non-pharmacological interventions—vapocoolant spray, Hugo point acupressure, and rhythmic breathing—on reducing pain intensity during arteriovenous fistula (AVF) cannulation in hemodialysis patients.

Methods and Materials: This randomized controlled trial was conducted in six hemodialysis centers in Iraq between December 2024 and January 2025. A total of 120 male patients undergoing regular hemodialysis were randomly allocated into four groups: control (n=34), rhythmic breathing (n=24), Hugo point acupressure (n=35), and vapocoolant spray (n=27). Pain intensity was measured immediately after needle insertion using the Visual Analog Scale (VAS). Interventions were applied 2 minutes before and during cannulation. Statistical analyses included Kruskal-Wallis, Mann-Whitney U test, and ANOVA.

Findings: All three interventions significantly reduced pain compared to the control group (P < 0.001). The vapocoolant spray group reported the lowest mean pain score (25.59 ± 3.6), followed by Hugo point acupressure (33.14 ± 4.26) and rhythmic breathing (37.79 ± 4.29). Vapocoolant spray was significantly more effective than the other methods (P < 0.001), and Hugo point acupressure was superior to rhythmic breathing (P < 0.001). No significant association was found between pain scores and demographic variables.

Conclusion: Vapocoolant spray, Hugo point acupressure, and rhythmic breathing are effective techniques for reducing AVF cannulation pain. Vapocoolant spray is the most effective and practical intervention, followed by acupressure and rhythmic breathing. These findings support incorporating these methods into routine nursing care to enhance patient comfort.