Effects of Ice Massage on Pain, Ecchymosis, Hematoma, and Patient Satisfaction When Applied Prior to Hemodialysis Arteriovenous Fistula Cannulation: A Crossover Trial

Purpose: To investigate the effects of precannulation ice massage on pain, ecchymosis, hematoma, and patient satisfaction during arteriovenous (AV) fistula cannulation in patients receiving maintenance hemodialysis. Methods: This nonrandomized, sequential crossover study included 40 hemodialysis patients. Each participant underwent routine cannulation (control condition) followed by precannulation ice massage (intervention condition) in subsequent sessions. Pain and satisfaction were assessed using a 10-point Visual Analog Scale. Ecchymosis and hematoma were measured using transparent grid film with computerized area calculation. Data were analyzed using repeated-measures analysis of variance and Cohen's d. Results: Ice massage significantly reduced pain during cannulation (Visual Analog Scale: 2.90 ± 1.08 vs. 6.12 ± 1.34; p < 0.001, d = 2.64), 72-h ecchymosis (2.02 ± 0.80 mm2 vs. 4.95 ± 1.41 mm2; p < 0.001, d = 2.55), and 72-h hematoma (1.57 ± 1.05 cm vs. 2.85 ± 0.83 cm; p < 0.001, d = 1.35). Patient satisfaction was significantly higher in the intervention condition (8.12 ± 0.72 vs. 5.02 ± 1.07; p < 0.001, d = 3.39). Conclusion: Precannulation ice massage is an effective, noninvasive intervention to reduce cannulation pain, minimize local complications, and enhance patient satisfaction. This simple and cost-effective method should be integrated into evidence-based hemodialysis care protocols. Trial Registration: ClinicalTrials.gov identifier: NCT06332118 (prospectively registered).