INTRODUCTION: Virtual reality headsets are increasingly used in medical procedures to help manage pain and anxiety. This study investigated the effect of a video played through a virtual reality headset on pain and anxiety levels during arteriovenous (AV) fistula needle insertion in patients undergoing hemodialysis. METHODS: This randomized controlled trial included 80 patients from a hemodialysis ward, with 40 in the intervention group and 40 in the control group. Data were collected using a Personal Information Form (developed by the researcher based on relevant literature to gather descriptive and medical characteristics), the visual analogue scale (VAS) for pain severity, and the State-Trait Anxiety Inventory to measure anxiety levels. The intervention group utilized a virtual reality headset during the procedure. The intervention was applied during a single dialysis treatment. FINDINGS: The mean pain score in the intervention (virtual reality headset) group was 6.2 ± 0.8, significantly lower than the control group's mean pain score of 8.3 ± 0.9 (p < 0.001). The mean State Anxiety Inventory score for the intervention (virtual reality headset) group was 41.9 ± 3.6, which was significantly lower than the control group's mean score of 64.6 ± 3.4 (p < 0.001). CONCLUSION: The results of this pilot study suggest that using a virtual reality headset significantly reduced both pain and anxiety in patients undergoing AV fistula needle insertion during hemodialysis. Further studies are indicated to evaluate the utility of virtual reality headset use over a prolonged period. TRIAL REGISTRATION: https://clinicaltrials.gov: NCT06776497.