Abstract: Objective To investigate the factors affecting the comfortable degree during arteriovenous fistula puncture and its effects on adverse events in maintenance hemodialysis (MHD) patients. Methods A total of 200 MHD patients were recruited at the Hemodialysis Center of Daping Hospital in Chongqing from September 2013 to October 2015. They were divided into subjective feeling of comfortable group and uncomfortable group using visual analogue scale. The qulity of life in the two groups was assessed by numerical pain rating scale, punctured limb activity form, and anxiety self-rating scale. The comfortable degree of puncture was obtained through questionnaire survey. The related adverse events during the whole investigation period in the 2 groups were then retrospectively analyzed. Results A total of 116 patients felt comfortable, and 84 patients felt uncomfortable during puncture. Pain scores (χ²=14.854, P=0.002), punctured limb activity scores (χ²=19.277, P＜0.001) and fear scores (χ²=9.059, P=0.029) were significantly lower in comfortable group than in the uncomfortable group. Puncture (β =-1.743, P=0.042), posture (β =-1.869, P=0.043), withdrawing the needle (β =- 1.961, P=0.043), emotion (β =- 1.824, P=0.027), support from medical staffs (β =-1.673, P=0.045) were closely related to the subjective comfortable feeling during puncture in MHD patients. The prevalence of thrombus formation (χ²=4.886, P=0.003), arteriovenous fistula occlusion (χ²=5.109, P=0.024), induration at puncture site (χ²=4.694, P=0.044), vascular stenosis (χ²=4.574, P=0.032) and hematoma (χ²=4.75, P=0.029) were significantly lower in comfortable group than in uncomfortable group (P<0.05). Conclusions Puncture, posture, withdrawing the needle, emotion and support from medical staffs impacted on the subjective comfortable degree during puncture in MHD patients. MHD patients with uncomfortable feeling had more pain and fear sensations and less activity at punctured side, resulting in the increase of adverse events after puncture and the decrease of dialysis effects and quality and life.

Key words: hemodialysis, arteriovenous puncture comfort, relevant factor, complications, fear.