Pain degree and skin damage during arterio-venous fistula puncture

The aims of this study were to evaluate the effect of needle bevel position on the degree of pain and damage to the skin covering the vein, in an arteriovenous fistula puncture, in haemodialysis patients. 48 patients with autologous arteriovenous fistula were studied. After puncture the patient was asked about the degree of pain perceived by means of an analogue visual scale and a descriptive verbal scale. When the needle was removed, the length of the cut made by the puncture was measured. The perceived pain assessed by analogue visual scale was greatest when the needle was punctured with the bevel facing upwards rather than downwards (median: 3 versus 2, p<0.003). The prick in the skin was greater when the puncture was made with the bevel facing upwards (19.7 +/- 5.6) rather than downwards (16.2 +/- 3.8, p<0.0001). It is concluded that arteriovenous fistula puncture with the bevel facing downward significantly reduces the degree of pain and the skin lesion at the point of puncture, without increasing the number of punctures.