Background: cannulation is an intervention that put a needle (AV Shunt or Femoral) into the skin to the blood vessel as a media to connect the vascular circulation with the hemodialysis machine during the hemodialysis process. Pain during arteriovenous fistula cannulation include into the acute pain category which is an uncomfortable sensation experienced by the patient in a short period when the syimulus is given, which is caused by a tissue damage in actual or potential with mild to severe pain intencity. Pain management is very important thing in all the health professions, especially in nursing line. Aim: the study was conducted to determine the effect of acupressure intervention at large intestinum point 4 (LI-4) on the reduction of AV-Fistula cannulation pain scale.Methods: this study uses a multiple case study design. Sample: this study took four case respondents with AV Shunting vascular access. Pain scale data before and after the intervention were taken using the numeric rating scale (NRS) pain assessment instrument. Result: based on the results of the study, the average pain scale before intervention was 6 and the average pain scale after the intervention was 4. Conclusions: from these results it can be concluded that acupressure intervention at point LI-4 has an effect on reducing the patient's AV-Fistula cannulation pain scale hemodialysis. Recommendations: acupressure intervention at LI-4 point can be applied by nurses as non pharmacologic pain management interventions to reduce pain in AV-fistula cannulation at hemodialysis patients.