Pain in patients under hemodialysis affects chronic renal patients' quality of life. Distraction has been effective in controlling pain induced by the insertion of needles. Once applied adequately, distraction promotes endorphins' release, with efficacy in acute pain. This study aims to evaluate pain perception while puncturing the hemodialysis device using an anti-stress ball as a distraction strategy.

Inclusion Criteria:

• adults over 18 years old
• able to read and write
• vascular access by a fistula or arteriovenous prosthesis, cannulated with a 15G needle
• vascular access at least with month old

Exclusion Criteria:

• patients under 18 years
• can't be able to read and/or write
• usage of topical anesthetics before treatment
• vascular access by a fistula or arteriovenous prosthesis, cannulated with smaller or larger 15G needles
• vascular access under one-month-old