Effects of cold application on pain and anxiety during chest tube removal among post operative cardiac surgery adult patients

Abstract

A study conducted to assess the effectiveness of cold application on Pain & Anxiety during Chest Tube Removal (CTR) among post operative cardiac surgery adult patients. Pre-test post-test control group experimental design was used. Post operative cardiac surgery adult patient of the selected hospital of Delhi were selected. The study sample was purposive sampling technique with random assignment of subjects into two groups: experimental group and control group. The sample size was 60 i.e. 30 in experimental group and 30 in control group. The control group received usual standard care during chest tube removal whereas experimental group received cold application with gel pack (Temp: 0-2 0 C) after wrapping it with sterile gauze, around chest tube (5cms) for a period of 15 minutes before CTR. The tools used for the study were structured questionnaire to obtain demographic data, standardized Numerical Pain Intensity Scale (NPIS) scale to assess pain, C.D. Speilberger's State Trait Anxiety inventory (STAI) scale to assess anxiety. The obtained data was analysed and interpreted in terms of the objectives of the study using descriptive and inferential statistics. The mean post test pain scores with cold application (1.13 ± 1.31; 0.27 ± 0.44; 0.27 ± 0.44) at zero minute, 15 minute and 30 minute respectively were significantly (< 0.05) lower than the mean pre-test score of 6.10 ± 1.27 in the experimental group without cold application. In control group, pre test mean pain score was 6.57 ± 1.12 as compared to mean post test pain score of 8.57 ± 0.49; 8.73 ± 0.57; 8.63 ± 0.48 at zero minute, 15 minute and 30 minute respectively. It indicates that cold application was effective to reduce pain among post operative cardiac surgery patients while removing chest tube. To evaluate the effectiveness of cold application on anxiety related to chest tube removal, in experimental group the mean post cold application anxiety scores 41.93 ± 2.21 were significantly lower (< 0.05) than the mean anxiety score of 53.47 ± 1.84 before cold application. In addition, the mean anxiety score were 53.31 ± 1.81 before CRT and 57.87 ± 3.21 after CRT among post operative cardiac surgery patient in control group. It indicates that the cold application on chest tube removal was effective in reducing anxiety among post operative cardiac surgery patient. Cold application is simple, cheap, non pharmacological anxiety and pain management strategy ensuring good results.

The effect of slow deep breathing relaxation exercise on pain levels during and post chest tube removal after coronary artery bypass graft surgery

“…Chest tubes are inserted into the pleural or mediastinal spaces after CABG surgery to remove fluid, air, and pus from the chest cavity and prevent potential cardiopulmonary complications [ [3] , [4] , [5] ]. However, ICU patients have reported chest tube removal (CTR) as an extremely painful and stressful procedure [ [4] , [5] , [6] , [7] , [8] , [9] ]. Pain experienced during CTR can result in deleterious neurohormonal and physiologic responses [ 2 ].…”

“…This involves glucagon and cortisol release, associated with insulin resistance and hyperglycemia [ 2 , 4 ]. These changes and reactions are considered early vital indicators of the need for a pain control regimen [ 8 , 10 ]. Studies have shown that most postoperative patients experience moderate to severe pain [ 11 , 12 ].…”

“…For nurses, pain management is a major concern. Researchers have explored the effects of different non-pharmacologic techniques in controlling pain during CTR, including techniques such as music therapy, quick relaxation [ 13 ], foot reflexology massage [ 3 ], cold therapy [ 4 , 5 , 8 , 10 ], hearing a beloved person’s voice [ 14 ], and slow deep breathing relaxation Exercise (SDBRE) [ 5 , 10 ]. SDBRE is among the simplest relaxation techniques nurses use in managing pain experienced by patients during CTR.…”

Effect of Spiritual Care on Chest Tube Removal Anxiety and Pain in Heart Surgery in Muslim Patients (Shia and Sunni)

“…Moreover, in patients whose post-surgery pain is not properly controlled, cardiac failure is increased three times and the rate of infection is increased five times (Soltani et al., 2017). In addition, untreated pain has adverse physiologic and metabolic effects on vital signs and on the immune, pulmonary, cardiovascular, gastrointestinal, and endocrine systems; it also causes distress and suffering for patients, respiratory distress and declined chest expansion, respiratory dysfunction with hypoxia, and increased sympathetic response, together with myocardial ischemia, increased general stress with an increased heart rate, increased cardiac output, and vessel contraction (Dave, 2016).…”

Effects of Cold Therapy on Pain and Anxiety During Needle Removal From Implanted Ports

“…Since pain affects the individual not only physiologically but also psychologically and behaviorally, the patient may also experience anxiety. [12][13][14] Studies have shown that the pain experienced during needle insertion into the implanted port in patients with cancer was also determined to cause anxiety. 2,4 In a study conducted by Gonzales and Rutledge, 15 anxiolytic drugs were administered to 32% of patients before needle insertion into the implanted port.…”