VALSALVA MANEUVER TO DECREASE PAIN INTENSITY DURING ARTERIOVENOUS FISTULA INSERTION IN HEMODIALYSIS PATIENTS

Abstract

VALSALVA MANEUVER TO DECREASE PAIN INTENSITY DURING ARTERIOVENOUS FISTULA INSERTION IN HEMODIALYSIS PATIENTS Mahruri Saputra1* , Ikhsanuddin Ahmad Harahap2 , Sutomo Kasiman3 1. Master Student, Faculty of Nursing Universitas Sumatera Utara, Medan 20222, Indonesia 2. Faculty of Nursing Universitas Sumatera Utara, Medan 20222, Indonesia 3. Faculty of Medicine Universitas Sumatera Utara, Medan 20222, Indonesia *E-mail: mahruri@stikesgetsempena.ac.id Abstract AV fistula allows external vascular access for hemodialysis patients. Because hemodialysis patients experience puncture wounds and stabbing pain approximately 300 times a year, development of methods to decrease pain intensity are of great importance. Some techniques, such as the Valsalva maneuver, are known to reduce pain. This study aims to assess the effect of the Valsalva maneuver on decreasing the intensity of AV fistula pain in patients receiving hemodialysis. The quasi-experimental research of pre and post without control applying consecutive sampling to get as many as 63 respondents. Pain intensity was measured by using the Numerical Pain Rating Scale (NPRS). The Valsalva maneuver was performed during insertion of the AV fistula needle for 16–20 seconds. The results showed significant differences in pain intensity between before and after the intervention with the difference in mean that is 1.35 (SD= 0.54), t= 19.70, p= 0.001. The Valsalva maneuver is effective in reducing the pain of AV fistula insertion because it stimulates the vagus nerve to induce an antinociceptive effect. Nurses are highly recommended to teach the Valsalva maneuver to patients undergoing routine hemodialysis. Keyword: AV fistula, hemodialysis, pain intensity, Valsalva maneuver