The add-on effect of the Mutsu-Senshi® skin cooling device for needle insertion pain in hemodialysis patients: a multicenter prospective study. Issue 1 (December 2016)

• Record Type: Journal Article
• Authors: Torato, Toshihiro; Iwagami, Masao; Kawaguchi, Hiroshi; Suzuki, Toshiaki; Yamamoto, Noriyuki; Matsuo, Shigeki; Ishikawa, Chiduru; Katagiri, Daisuke; Hamasaki, Yoshifumi; Hanafusa, Norio; Nangaku, Masaomi; Sanaka, Tsutomu; Noiri, Eisei
• Is Part Of: Renal replacement therapy. Volume 2:Issue 1(2016)
• Page Start: 1
• Page End: 7
• Publication Date: 2016-12
• Subjects: Hemodialysis -- Needle insertion -- Skin cooling -- Pain -- Arteriovenous fistula; Kidneys -- Diseases -- Periodicals; Acute renal failure -- Treatment -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis -- Periodicals; 616.61406
• DOI: 10.1186/s41100-016-0022-6
• Languages: English
• ISSNs: 2059-1381

Abstract

Abstract Background Needle insertion pain associated with maintenance hemodialysis (HD) causes considerable stress on HD patients with native arteriovenous fistula. Skin cooling has been suggested to modify pain sensitivity and reduce needle insertion pain. Recently, a skin cooling device, named Mutsu-Senshi®, has been developed to decrease local skin temperature to 21 °C smoothly and safely at the bedside. Therefore, we examined the effectiveness of Mutsu-Senshi® in 4 HD centers in Japan. Methods We recruited adult patients receiving maintenance HD. After 1 week of HD in a conventional way, Mutsu-Senshi® was additionally used before the start of every HD in the second week. The disinfected Mutsu-Senshi® was placed on the disinfected access site before needle insertion to decrease skin temperature to 21 °C in 1 min. At the end of the second week, patients were asked to score relative changes in needle insertion pain on a modified visual analog scale (VAS) on a tablet computer in private, from −100 indicating a marked increase in pain intensity with Mutsu-Senshi® to +100 indicating a marked reduction in pain intensity with Mutsu-Senshi®. Results were presented on scatter and box plots, with subgroup analyses according to age, sex, HD vintage, reasons for end-stage renal disease, needle insertion site, the use of a lidocaine patch, and the diameter of needles used. Finally, a multivariate logistic regression analysis was conducted to examine factors associated with the patients' preferences for Mutsu-Senshi®. Results Of the 98 study participants with a native arteriovenous fistula (mean age 60.5 [standard deviation 13.8], men 66 %), 63 (64 %) rated Mutsu-Senshi® more favorably with modified VAS scores of >0. The median score was +29 with an interquartile range from ±0 to +58. Subgroup analysis revealed that patients using dialysis needles with larger diameters (15–17 gauge) tended to favor Mutsu-Senshi® compared with those using needles with a smaller diameter (18 gauge). Needle diameter was also an independent factor associated with favoring Mutsu-Senshi®. Conclusions These multicenter prospective study data suggest that the majority of patients receiving maintenance HD favor the use of the Mutsu-Senshi® skin cooling device before needle insertion. A group of patients using needles with larger diameters may benefit more from Mutsu-Senshi®. Trial registration UMIN000011802