Background: Arteriovenous Fistula (AVF) puncture is a crucial component of Hemodialysis (HD) that
is often accompanied by significant pain, particularly among pediatric patients. Mitigating this pain
using promising adjunctive non-pharmacological therapy such as Virtual Reality (VR) is pivotal. The
study aimed to determine the effect of VR on pain intensity associated with AVF puncture among
children undergoing HD. Settings: The study was conducted at the HD units of Smouha Children's
University Hospital and Sporting Students' Hospital in Alexandria, Egypt. Subjects: A convenient
sample of 30 children undergoing HD through AVF comprised the study subjects. Children's ages
ranged from 6 to 12 years. All subjects were assigned to the control and then to the VR group cross
overly. Tools: Three tools were used to collect the necessary data namely, Characteristics of Children
and their Medical and Physiological Data Assessment Sheet, Modified Children's Hospital of Eastern
Ontario Pain Scale, and Wong-Baker Faces Pain Rating Scale. Results: it was found that 76.7% of
children in the control group were suffering from severe pain during AVF puncture compared to 33.3%
of children in the VR group. Also, most children in the VR group experienced mild pain (93.3%)
immediately after the AVF puncture, compared to one-third of the control group (33.3%) as 60.0%
experienced moderate pain. Conclusion: It was concluded that the VR technique minimized pain
responses significantly during and immediately after AVF puncture among children undergoing HD.
Recommendation: Virtual reality should be incorporated into the HD units' care protocols to alleviate
children's pain.