Breathing Exercises for Pain and Anxiety During Arteriovenous Fistula Cannulation

NCT07427875 | Not Yet Recruiting

• 1 other identifier: 78017789/050.01.04/3392078
• Study Type: interventional
• Target: 90
• Locations: 1 country
• Sites: 1

Brief Summary

This study aims to evaluate the effects of guided 4-7-8 and diaphragmatic breathing exercises performed during arteriovenous fistula cannulation on pain, anxiety, and comfort levels in patients undergoing hemodialysis treatment. Hemodialysis patients often experience pain and anxiety during fistula cannulation, which can negatively affect the treatment process and patient comfort. The study will be conducted as a three-arm randomized controlled trial. Participants will be randomly assigned to the 4-7-8 breathing exercise group, the diaphragmatic breathing exercise group, or the control group receiving usual care. In the intervention groups, breathing exercises will be performed with guidance before and during cannulation. The study anticipates that breathing exercises will reduce pain and anxiety, increase comfort levels, and contribute as an easily applicable, side-effect-free method to nursing care. The findings are expected to support the use of non-pharmacological interventions in hemodialysis patients.

Conditions

Hemodialysis; Breathing Exercises; Pain; Anxiety; Arteriovenous Fistula Cannulation; Comfort

Outcome Measures

Primary Outcomes (1)

• Anxiety level during arteriovenous fistula cannulation

  State anxiety will be measured using the State-Trait Anxiety Inventory (STAI) state subscale. The subscale consists of 20 items rated on a four-point Likert scale. Total scores range from 20 to 80, with higher scores indicating greater anxiety. Anxiety will be assessed during arteriovenous fistula cannulation to evaluate the immediate effect of the intervention.

  During arteriovenous fistula cannulation

Secondary Outcomes (8)

• Pain intensity during arteriovenous fistula cannulation

  During arteriovenous fistula cannulation.

• Systolic blood pressure

  During arteriovenous fistula cannulation.

• Diastolic blood pressure

  During arteriovenous fistula cannulation

• Heart rate

  During arteriovenous fistula cannulation.

• Respiratory rate

  During arteriovenous fistula cannulation

Other Outcomes (1)

• Comfort level during arteriovenous fistula cannulation

  During arteriovenous fistula cannulation.

Study Arms (3)

4-7-8 Breathing Exercise Group

EXPERIMENTAL

Participants in this experimental group will receive guided 4-7-8 breathing exercises before and during arteriovenous fistula cannulation in addition to routine hemodialysis care. The 4-7-8 breathing technique consists of inhaling through the nose for 4 seconds, holding the breath for 7 seconds, and exhaling slowly through the mouth for 8 seconds. The breathing exercises will be performed under researcher guidance according to a standardized protocol during each cannulation session.

Behavioral: Guided 4-7-8 Breathing Exercise

Diaphragmatic Breathing Exercise Group

EXPERIMENTAL

Participants in this experimental group will receive guided diaphragmatic breathing exercises before and during arteriovenous fistula cannulation in addition to routine hemodialysis care. The intervention involves slow and deep breathing with diaphragmatic expansion, emphasizing abdominal movement rather than chest movement. The breathing exercises will be performed under researcher guidance according to a standardized protocol during each cannulation session.

Behavioral: Guided Diaphragmatic Breathing Exercise

Control Group (Usual Care)

OTHER

Participants in this control group will receive routine nursing care during arteriovenous fistula cannulation according to standard clinical practice. No breathing exercise or additional intervention will be applied.

Other: routine care

Interventions

Guided 4-7-8 Breathing Exercise BEHAVIORAL

Katılımcılar, rutin hemodiyaliz bakımına ek olarak, arteriyovenöz fistül kanülasyonu öncesinde ve sırasında rehberli 4-7-8 nefes egzersizi yapacaklardır. Bu teknik, 4 saniye boyunca burundan nefes almak, 7 saniye boyunca nefesini tutmak ve 8 saniye boyunca ağızdan yavaşça nefes vermekten oluşur. Egzersiz, her kanülasyon seansı sırasında standart bir protokole göre araştırmacıların rehberliğinde uygulanacaktır.

Also known as: 4-7-8 Breathing Technique

4-7-8 Breathing Exercise Group

Guided Diaphragmatic Breathing Exercise BEHAVIORAL

Participants will perform guided diaphragmatic breathing exercises before and during arteriovenous fistula cannulation in addition to routine hemodialysis care. The intervention involves slow and deep breathing with diaphragmatic expansion, emphasizing abdominal movement rather than chest movement. The breathing exercises will be administered under researcher guidance according to a standardized protocol during each cannulation session.

Also known as: Diaphragmatic Breathing Technique

Diaphragmatic Breathing Exercise Group

routine care OTHER

Participants in this group will receive routine nursing care during arteriovenous fistula cannulation according to standard clinical practice. No breathing exercise or additional intervention will be applied.

Also known as: Usual Care

Control Group (Usual Care)

Eligibility Criteria

• Age: 18 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Be 18 years of age or older
• Have been receiving regular hemodialysis treatment for at least 6 months
• Undergo hemodialysis via an AV fistula
• Have the physical and cognitive ability to perform breathing exercises during cannulation
• Have a cognitive level sufficient to communicate

You may not qualify if:

• Those with pain level 4 or higher
• Those using painkillers and antidepressants
• Those with a history of acute complications
• Patients using a vascular access route other than an AV fistula
• Those with severe cognitive impairment or a neurological disease that impairs communication
• Those with severe cardiopulmonary disease that may contraindicate breathing exercises Patients with an infection requiring contact isolation

Sponsors & Collaborators

• Emine Kaplan Serin: lead
• Mersin University: collaborator

Study Sites (1)

Mersin University Faculty of Nursing Çiftlikköy Campus 33343, Yenişehir / Mersin

Mersin, Yenişehir, 33000, Turkey (Türkiye)

Location

Related Publications (2)

• İlgin, V. E., & Yayla, A. (2023). Effect of the 4-7-8 breathing technique on pain level and sleep quality of patients after laparoscopic bariatric surgery: A randomized controlled study. Bariatric Surgical Practice and Patient Care, 18, 225-232. https://doi.org/10.1089/bari.2022.0044

  BACKGROUND

• Serbest Baz, A. N. (2025). The effect of using the 4-7-8 breathing technique on postoperative shoulder pain and pulmonary functions after laparoscopic cholecystectomy (Unpublished doctoral dissertation). Mersin University.

  RESULT

Related Links

• Related Info

MeSH Terms

Conditions

Pain; Anxiety Disorders

Condition Hierarchy (Ancestors)

Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Mental Disorders

Study Officials

• Emine KAPLAN SERİN, Associate Professor

  Mersin University, Faculty of Nursing, Department of Internal Medicine Nursing, Mersin/ Türkiye.

  STUDY DIRECTOR

Central Study Contacts

Semra USTA Usta, PhD Student

CONTACT

+905436275110; ustasemra80@gmail.com

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: February 8, 2026
• First Posted: February 23, 2026
• Study Start: February 10, 2026
• Primary Completion (Estimated): August 1, 2026
• Study Completion (Estimated): October 1, 2026
• Last Updated: February 24, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)