Rhythmic Breathing Integrated with Hugo Point Acupressure V.S. Vapocoolant Spray on Pain Intensity During Needle Insertion into Arteriovenous Fistula in Hemodialysis Patients:A Randomized Controlled Trial

Compare combination of rhythmic breathing with Hugo point acupressure versus vapocoolant spray in reducing pain during needle insertion.

An experimental design will be conducted to compare Rhythmic Breathing combined with Hugo Point Acupressure versus vapocoolant spray in alleviating pain. A total of 120 participants will be included in the study, with 24 participants in each group.

In Dhi Qar Governorate, Iraq, covering several hemodialysis centers, including Al-Hussein Center, Souq Al-Shuyukh Dialysis Center. The study will involve over 500 male patients aged 18 years or older, aiming to assess both administrative needs and the accessibility of the research population.

Inclusion criteria :male hemodialysis patients aged 18+, with an arteriovenous fistula, alert, able to speak, not taking analgesics. Exclusion criteria:with unrelated severe pain, allergies to vapocoolant spray, recent surgery near the fistula, cognitive impairments, infections at the fistula site, or inflammation at the Hugo point.

Rhythmic Breathing: Participants will practice deep breathing for two minutes before and during needle insertion, inhaling, holding, and exhaling for a count of three. Hugo Point Acupressure: The Hugo Point on the hand will be massaged with moderate pressure for two minutes before and during needle insertion, using a cycle of 10 seconds of pressure and 2 seconds of rest. Combination of Rhythmic Breathing and Acupressure: Both techniques will be applied together for two minutes before and during needle insertion. Vapocoolant Spray: The spray will be applied to the skin for 3-4 seconds, followed by a 10-second evaporation, before needle insertion.

Pain Intensity

The sampling methodology encompasses a dual-phase procedure designed to procure representative constituents of the target population, specifically male patients undergoing hemodialysis who are subjected to needle insertion into arteriovenous fistulas. In the initial phase, researcher will disseminate two distinct categories of cards: one denoting the patient's eligibility for participation in the study (orange), and the other signifying ineligibility (gray). Patients who are in possession of the eligible card will subsequently select from one of five colored cards , each representing a different study condition: White = Control group Yellow = Rhythmic breathing only Green = Hugo point acupressure only Blue = Vapocoolant spray only red = Rhythmic breathing integrated with Hugo point acupressure

The researcher is acknowledging the scientific community to have verifiable findings of the study. sharing plan includes making all the related data available through publishing the study report in peer-reviewed reputable journals.

God willing, once finishing the process of data collection, analysis and successfully publishing the manuscript, all the related files will become available for 6 months after publications

All the related files will be shared with any scientific interested parties.

It may be used after seeking the author's permission and acknowledging his contribution.

The author's professional e-mail that will be available with the published manuscript can be used to contact the author. e-Mail: Hasan.band2302m@conursing.uobaghdad.edu.iq

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Profound appreciations are due to the IRCT members for their genuine efforts in helping researchers fulfilling their academic endeavors.