Needle-related distress in dialysis represents a significant clinical hurdle for nephrology teams and patients worldwide. Although haemodialysis is a life-sustaining treatment, the requirement for frequent large-bore needle insertions often leads to substantial psychological burden. Consequently, many patients suffer in silence, which can ultimately impact their adherence to treatment and overall quality of life.

A recent pilot study, termed the INJECT study, evaluated a novel intervention to address this issue. The programme combined psychologist evaluations, self-managed online cognitive behavioural therapy (CBT), and comprehensive nursing education. Researchers aimed to determine if this multi-pronged approach could effectively reduce the fear and anxiety associated with vascular access cannulation in a tertiary renal unit.

Challenges in Managing Needle-Related Distress in Dialysis

The study faced several implementation barriers that hindered the progression to a full clinical trial. Specifically, recruitment proved difficult as only 18 out of 39 referred patients consented to the intervention. The COVID-19 pandemic significantly disrupted patient outreach and engagement during the study period. Furthermore, researchers noted a clear discrepancy between the distress patients reported and what nurses observed during treatment.

Moreover, the inherent disease and treatment burden of end-stage kidney disease made sustaining engagement with an online CBT programme difficult. Many patients struggled to find the time or energy to complete the modules while managing their complex health needs. Therefore, while those who completed the programme found it useful, the overall attrition rate remained high.

The Role of Nursing Education in Reducing Distress

In contrast to the challenges faced with patient-led CBT, the nursing education component of the study was highly successful. A total of 133 dialysis nurses completed the training programme. This education focused on recognising needle fear and implementing best-practice cannulation techniques. Consequently, nurses reported significant improvements in their knowledge and confidence regarding the management of needle-related distress in dialysis.

This finding suggests that while self-managed psychological interventions may be difficult for patients to navigate alone, empowering the clinical staff provides a more sustainable path forward. Integrating psychological support into routine nursing care can create a more empathetic and supportive environment. This shift may help de-escalate patient anxiety before it becomes a barrier to life-saving care.

Practical Implications for Nephrology Practice

Ultimately, the pilot study concluded that a purely self-managed CBT model is currently unsuitable for large-scale clinical trials in this population. However, the success of the nurse education module highlights an alternative strategy. Future interventions should perhaps focus on staff-led support and integrated psychological screening rather than relying solely on patient-led digital tools.

Frequently Asked Questions

Why is needle-related distress in dialysis often under-recognised?

There is often a discrepancy between a patient's internal experience and the external signs observed by clinicians. Many patients learn to tolerate distress as an inevitable part of survival, while busy clinical environments may focus more on technical success than psychological comfort.

Can online CBT help patients with needle phobia?

The study indicated that for the small group of patients who completed the modules, needle-related distress was reduced. However, high treatment burden makes it difficult for most dialysis patients to maintain long-term engagement with self-managed digital programmes.

How does nurse training improve the patient experience during dialysis?

Education helps nurses identify subtle signs of anxiety and provides them with communication tools to support patients. Improved technical confidence and empathy from the nursing staff can significantly lower the patient's perceived stress during the cannulation process.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or a professional relationship. Always seek the advice of a qualified healthcare provider regarding any medical condition or treatment. Refer to the latest local and national guidelines for clinical practice.

References

Radisic G et al. Process evaluation of a pilot study of a self-managed, online cognitive behavioural therapy programme to address needle-related distress in haemodialysis recipients. J Vasc Access. 2026 May 05. doi: 10.1177/11297298261437914. PMID: 42083932.

Richmond H, et al. Cognitive behavioural therapy for needle phobia in chronic disease management: A systematic review. Journal of Psychosomatic Research. 2020.

Duncanson E, et al. The prevalence and impact of needle-related distress in patients receiving maintenance haemodialysis. PLOS ONE. 2020.