الفهرس 
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Abstract
Although advances in dialysis treatment have contributed to improve survival of patients with ESRD, End stage renal disease should have replacement therapy for lifelong either daily HD or PD and transplantation. Patient who will be managed by HD is as a lifelong treatment need VAAVA. AVA should be punctured every session either in constant or different sites and the both technique will affect the quality dialysis session and purification of the blood
Aim of the Study
The aim of this study is to assess the physical and psychological effect of constant site and different sites of punctures on haemodialysis patients.
Research question:
• What are the effects of constant site puncture of patients undergoing haemodialysis on his/her physical and psychological out comes?
• What is the effect of different sites puncture of patient undergoing haemodialysis on his/her physical and psychological out comes?
Research design: Descriptive comparative design, was used to conduct this study.
Setting:
The study was conducted in the haemodialysis unit in EL-Demerdash Hospital, Ain Shams University.
Subjects size and characteristics:
• Purposive sample, all the available patients undergoing haemodialysis programme in the previous mentioned setting.
Tools of data collection:
Tools for gathering data were used to achieve the purpose of the current study and they include:
1- An interview-questionnaire sheet.
It was developed in Arabic language by the researcher after reviewing the related literatures. It included the following parts.
Part I: The first part concerning with demographic data of patients (age, sex, level of education, marital status, jobs, etc….)
Part II: It assesses past medical and surgical history of the patient.
Part III: It assesses patient knowledge regarding (arterio venous fistula).
Part IV: pain scale
It assesses pain level during puncture (either in constant site and on different sites it is adopted from (Pain Intensity Instruments, 2012).
Part IIV: Anxiety scale
It assesses the level of anxiety for the both groups of patients under study.
Part IIIV: Depression scale
It assesses the level of depression for the both groups of patients under study.
2- Physical assessment sheet
It developed by the researcher after reviewing literature to assess complications after constant sites and different sites puncture technique as (redness, aneurysm…etc).
The main findings of the study can be summarized as following:
• As regards there no statistically difference between constant site and different sites puncture groups according to their demographic data, with p-value >0.05
• Statistically significant differences were found between constant site and different sites puncture groups according to medical history regarding preferred type of insertion, period of survival of arterio venous fistula and number of fistula complications. with p-value <0.05
• No statistically significant differences were found between constant site and different sites puncture according to their level of knowledge regarding renal failure, arterio venous fistula and pre and post precautions measures of the dialysis session in the both groups. with p-value >0.05
• Highly statistically significant difference between constant site and different sites puncture groups according to their pain scale. with p-value<0.01
• Statistically significant difference between constant site and different sites puncture groups according to their Hamilton anxiety rating scale. with p-value <0.05
• Statistically significant difference regarding mild and moderate of level of depression in the both groups. with p-value <0.05
• Highly statistically significant difference between the both group according to all arterio venous fistula complications. with p-value <0.01
• Statistically significant difference only between the gender and level of knowledge of the both groups, with p-value (<0.05).
• Statistically significant difference relation only between the age, frequency of session per week and level of pain of the both groups, with p-value (<0.05).
• Statistically significant difference relation only between the sex and level of anxiety of the both groups, with p-value (<0.05).
• Statistically significant difference relation only between the sex and level of depression of the both groups, with p-value (<0.05).
• Statistically significant difference relation only between the marital status and the frequency of session per week and patient’s complications of the arterio venous fistula in both group with no statistical significant difference in all items between the two groups. with p-value <0.05
• Positive correlation and significant between total satisfactory knowledge with pain, anxiety and depression in constant puncture group, while the different puncture group showed only positive correlation and significant between the total satisfactory knowledge with pain and depression.
Conclusion
The result of this study concluded that there are difference between using constant site and different sites of puncture on haemodialysis patient for their physical and psychological state, especially pain which increasing more in patients using different sites rather than constant, and highly statistically significant difference according to physical assessment of patients in both group during puncture using constant site puncture more patients preferred using constant site rather than different site puncture especially female patients, in spite complications is more in using constant site puncture rather than using different site puncture.
Using different site of puncture resulted in:
1- A shorten fistula survival.
2- Feeling of pain for the patients.
3- Feeling of anxiety and depression for the patients.
Recommendations
Based on the results and conclusion of this study, the following recommendations are suggested to:
1. Psychological support for the haemodialysis patient during puncture if it was from constant site or different sites is needed.
2. Follow up continuously for the haemodialysis patients for assessing the changes in their body during puncture.