Dialysis Needle-Related Distress: Patient Perspectives on Identification, Prevention, and Management

Emily L Duncanson; Anna Chur-Hansen; Richard K Le Leu; Luke Macauley; Anne L J Burke; Fiona F Donnelly; Kathryn L Collins; Stephen P McDonald; Shilpanjali Jesudason

doi:10.1016/j.ekir.2023.09.011

Dialysis Needle-Related Distress: Patient Perspectives on Identification, Prevention, and Management

Kidney Int Rep. 2023 Sep 14;8(12):2625-2634. doi: 10.1016/j.ekir.2023.09.011. eCollection 2023 Dec.

Authors

Emily L Duncanson^{1

2

3}, Anna Chur-Hansen¹, Richard K Le Leu^{2

4}, Luke Macauley^{1

2}, Anne L J Burke^{1

5}, Fiona F Donnelly², Kathryn L Collins^{1

5}, Stephen P McDonald^{2

3

4}, Shilpanjali Jesudason^{2

4}

Affiliations

¹ School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
² Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, South Australia, Australia.
³ Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
⁴ School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
⁵ Psychology Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia.

Abstract

Introduction: Needle-related distress is common among people receiving hemodialysis and affects quality of life and treatment decisions, yet little evidence exists to guide management. This study explored patients' experiences of needle-related distress to inform the development of prevention, identification, and management strategies.

Methods: Semistructured interviews concerning dialysis cannulation, needle-related distress, and potential solutions were conducted with people with current or recent experience of hemodialysis (N = 15) from a tertiary hospital-based service. Interviews ceased at thematic saturation. Transcripts were analyzed thematically.

Results: There were 4 themes and 11 subthemes generated: (i) uncovering a hidden source of distress (dismissal and minimization by others; suffering in silence to stay alive; preparation, assessment, and education); (ii) coping with cannulation pain and trauma (interaction between physical damage, pain, and distress; operator dependency-the importance of nurse skill and technique); (iii) the environment created by dialysis nurses (emotional transference; communication during cannulation; valuing empathy and person-centered care; a psychosocially supportive dialysis unit); and (iv) supporting patient self-management of distress (accessing tools to help themselves; distraction to reduce distress).

Conclusion: Needle-related distress is an often-hidden element of the hemodialysis experience. Patients learn to tolerate it as an inevitable part of dialysis for survival. Nurses' technical skills and the dialysis environment they create are key determinants of the patient cannulation experience. Proposed solutions include psychological screening, education for patients to self-manage distress, and training for nurses in communication and providing relevant psychological support.

Keywords: arteriovenous fistula; cannulation; hemodialysis; patient perspectives; qualitative research; vascular access.