Study aim: Comparison of the Effect of Rhythmic Respiration and Lidocaine Spray on the Severity of Arteriovenous Fistula Venipuncture Pain in Patients undergoing Hemodialysis Design: Two-group self-control, blinded clinical trial, 54 patients,Randomization with quadruple blocks Settings and conduct: Two methods of rhythmic breathing and Lidocaine spray are known methods of pain relief. In this study, a comparison of these two methods on the severity of fistula canola pain in patients of Nikan Farda Hemodialysis Center in Mashhad is investigated.Patients are randomly assigned to two groups: rhythmic respiration and Lidocaine spray.In each group for control, the pain intensity of fistula cannulation is evaluated before the intervention. To blind the study, the help of a researcher who does not know the type of intervention is used to assess the pain. Participants/Inclusion and exclusion criteria: Inclusion criteria: Be between 18 and 60 years old. Willing to cooperate and participate in research. Known insensitivity to Lidocaine. Do not have verbal, visual or auditory impairment. Criteria for not entering: Onset of other chronic pain that affects the assessment of pain due to the needle entering the arteries of the fistula. Failure to insert the needle into the arteries of the fistula area in the first attempt and the need to repeat the cannulation. Intervention groups: In the situation without intervention in both groups, no intervention is performed. In the first intervention group, the effect of rhythmic breathing on the pain intensity of dialysis fistula cannulation is investigated. In the second intervention group, the effect of 10% Lidocaine spray on the severity of dialysis fistula cannulation pain is investigated. Main outcome variables: Dialysis fistula cannulation pain