Arteriovenous fistulae are preferred among methods of providing blood access for hemodialysis. For each hemodialysis treatment, the fistula is cannulated usually with two needles. One, the arterial needle, allows the blood to be withdrawn from the patient into the dialysis circuit and then it is returned by the second or venous needle. The success of arteriovenous fistula cannulation is dependent on many variables and these are affect the dialysis adequacy.

As hemodialysis prescriptions are usually three times weekly (4 to 8 h), a fistula or graft for hemodialysis will be punctured twice each dialysis treatment or at least 312 times per year. To allow healing of the tissues damaged during each cannulation, optimal cannulation practice is required by rotation of the needle insertion sites each dialysis treatment. Vascular access (VA) has been justly described as both the lifeline and the Achilles' heel of hemodialysis therapy, making blood purification itself possible while simultaneously often constituting a limiting factor in treatment adequacy.

Inclusion Criteria:

• 18 and older years of age
• Have arteriovenous fistula
• Being on hemodialysis therapy for 4 hours a day on 3 days per week for at least 6 months
• Volunteering to participate in the study
• Have not communication problem

Exclusion Criteria:

• Younger than 18 years old
• Not volunteering to participate in the study
• Have communication problem
• Being on shorter hemodialysis therapy for 4 hours a day on 3 days per week for at least 6 months

Being on hemodialysis therapy for 4 hours a day on 3 days per week for at least 6 months and 18 and older years of age who has arteriovenous fistula

All-Cause Mortality, Serious, and Other (Not Including Serious) Adverse Events were not monitored/assessed