Chest Tube Removal: Efficacy of Cold Application and Breathing Exercise on Pain and Anxiety Level

Abstract

Context: Post-cardiothoracic surgical chest tube removal (CTR) is considered a painful technique and one of the most painful patients' experiences in the intensive care unit. Painkillers are the most prevalent method to relieve the pain, but the patient may not respond well and achieved complete relaxation. Regardless of scientific advances, no efficient action is possessed to decrease pain and anxiety because of it.
 Aim: This study aimed to investigate the efficacy of cold application and breathing exercises on pain and anxiety levels following chest tube removal.
 Methods: A quasi-experimental design (one group pre/post-test) was utilized to achieve the aim. This study was conducted in the Intensive Care Unit at the Cardio-Thoracic Academy Affiliated to Ain Shams University Hospital, Cairo. A Purposive sample included 60 patients undergoing cardiothoracic surgical procedures and having at least two chest tubes in place. Data were collected using three tools; a structured interviewing questionnaire, pain intensity assessment visual numeric scale, short-form McGill pain assessment questionnaire, modified comfort scale, and breathing exercise checklist.
 Results: This study revealed that patients suffer from severe pain before CTR without cold application and breathing exercise (61.7%), or with the application of them (66.7%), the pain level improved during removal as 80% of patients display no pain when using the cold application and breathing exercise that increased to 95% after 10-15 minute of removal compared to 8.3% when cold application and breathing exercise not used. Otherwise, the anxiety level decreased during CTR as 58.3% had mild anxiety level with cold application and breathing exercises compared to 38.3% had a very severe anxiety level. Mild anxiety level increased to 91.7% after 10-15 minutes of CTR compared to 16.7 % when CTR without application.
 Conclusion: Cold application and breathing exercises are useful for reducing patients' pain and anxiety levels associated with chest tube removal after cardiothoracic surgery. Encouraging critical care nurses to use cold application and breathing exercises as a non-pharmacological pain relief technique during chest tube removal was highly recommended.

The effect of virtual reality glasses on reducing pain during chest tube removal

“…In this study, the pre-procedure baseline pain scores of the intervention and control groups were found to be similar. Similarly, it is reported in the literature that there is no significant difference between the groups in terms of pain score before ChTR [20][21][22][23][24][25][26][27].…”

“…While there was no difference in the anxiety scores of the groups before the procedure, Aktaş and Karabulut [33] reported in their study that there was no difference between the preprocedure anxiety scores of the groups treated with cold therapy, music therapy, and lidocaine spray during the ChTR procedure and the control group. Elmetwalyl and Sayed [22] found that anxiety scores were similar in the intervention cold application and relaxation exercise) and control groups before the ChTR procedure. Similar results were obtained in other studies in the literature [21,27].…”

“…In other studies investigating the effectiveness of cold application on pain, it was stated that the intervention group had lower pain score than the control group immediately after ChTR [20,25]. Elmetwalyl and Sayed [22] elucidated that pain score during the procedure was lower in the intervention group undergoing cold application and relaxation exercise compared to the control group (1.23 versus 3.60). Similar results were obtained in other studies in the literature [21,24,26].…”

Severity of Pain and Anxiety before Chest Tube Removal among Cardiac Surgeries Patients

“…Also Majority of the patient in were married (80%). Table (4) illustrates that the majority of the studied patients had undergone valve surgery (55%). It also illustrates that (46.7%) in the studied patients had mediastinal chest tube.…”

Breathing Exercises for Pain Management in Cancer Survivors: A Systematic Review

“…Breathing exercise by changing breathing depth and frequency (Brown et al, 2013), as one type of nonpharmacological interventions, has demonstrated the benefit of pain relief in various conditions (Elmetwaly & El Sayed, 2020;Purnamasari et al, 2020;Sasongko et al, 2019). Although clear mechanisms of the breathing exercises for pain reduction have not yet been established, the proposed baroreflex theory posits that breathing manipulation can activate baroreflex, which leads to decreased pain sensitivity (Hassan Jafari et al, 2017).…”