Background: Pain and anxiety during puncture arteriovenous fistula cannulation remain a common problem for hemodialysis elderly patients. Cryotherapy intervention is a non-pharmacological, simple, and cheap treatment. Aim: The present study aimed to evaluate the effect of cryotherapy intervention on pain and anxiety during arteriovenous fistula punctures among elderly patients undergoing hemodialysis. Design: A quasi-experimental pretest-and-posttest design was utilized. Setting: The study was conducted at the hemodialysis unit at the internal medicine department of Zagazig University Hospital and the hemodialysis unit at Al Ahrar hospital affiliated with the Ministry of Health. Subject: A purposive sample of 60 elderly patients who fulfilled the study inclusion criteria. Tools: Three tools were used. Tool I: Structured Interview Questionnaire to assess elderly patients demographic characteristics, medical history, and knowledge regarding cryotherapy intervention. Tool II: Numerical Rating Pain scale. Tool III: Beck Anxiety Inventory (BAI) scale. Results: The results revealed post-intervention a statistically significant difference in total mean knowledge, pain, and anxiety score among studied elderly patients pre and post-intervention. Before the intervention, total mean scores were 2.22+2.19, 6.75+1.48, and 35.78+6.32 respectively. In the post-intervention phase, the knowledge was improved to 8.83+1.58, and anxiety and pain decreased to 4.68+1.42 and 23.78+5.06. This change was statistically significant. Conclusion: Cryotherapy intervention was found to be effective in reducing pain and anxiety during arteriovenous fistula punctures among elderly patients undergoing hemodialysis. Recommendation: It is recommended that hemodialysis units must involve cryotherapy intervention for managing needle puncture pain in routine care for hemodialysis patients.