Cold Application and Breathing Exercises to Reduce Pain and Anxiety During Chest Tube Removal

Naglaa Mohamed El Mokadem

doi:10.11648/j.ajns.20170604.12

Abstract

Chest tube insertion following chest trauma or Coronary Artery Bypass Grafting (CABG) surgery is a frequent practice. Patients who undergo chest tube removal experience moderate to severe pain. Patients always described chest tube removal as a painful and frightening experience. Cold application and deep breathing exercise are effective non-pharmacological techniques to reduce pain and anxiety during chest tube removal. The aim of the study was to examine the effect of cold application and breathing exercises technique on pain and anxiety level during chest tube removal. A convenient sample of 120 patients. A quasi experimental design was used (study/control). Surgical intensive care unites at Menoufia University Hospital, Shebin EL-Kome. Visual Analog Scale for Pain (VAS) used to measure pain intensity during chest tube removal. Hamilton Anxiety Scale used to measure the anxiety level during chest tube removal. There was a statistically significant difference between study and control group regarding pain intensity post intervention. There was a statistically significant difference between study and control group regarding anxiety level post intervention. Using cold application and breathing exercise during chest tube removal is an effective practice to reduce pain intensity and anxiety level during chest tube removal. Encourage critical care nurses to develop practice guidelines for pain management during chest tube removal including application of cold and deep breathing exercise as a non pharmacological measure during chest tube removal.

Highlights

Insertion of chest tube following chest trauma or Coronary Artery Bypass Grafting surgery is a frequent practice [1]
The critical care nurse plays an important role for pain management during chest tube removal using non-pharmacological pain-relieving methods such as cold application and breathing exercise instead of administration of analgesic or pain-relieving drugs such as opioids and Non Steroidal Anti Inflammatory Drugs (NSAID) which is the most common intervention used for pain management during chest tube removal
The study findings suggested that using ice application and breathing exercise can decrease total mean score of anxiety level immediately, 15 and 30 minutes after chest tube removal in the study group post intervention compared to the control group

Summary

Introduction

Insertion of chest tube following chest trauma or Coronary Artery Bypass Grafting surgery is a frequent practice [1]. Chest tube facilitates drainage of air and blood from the pleural, pericardial or mediastinal cavity. Patients who undergo chest tube removal experience moderate to severe pain. This pain results from the chest endothelial tissue which is adhered to the tube tip and at the time of tube removal the pulling force will shear this adhesion causing severe pain [3]. Patients always describe chest tube removal as a painful and frightening experience [4]. Anxiety and discomfort are unpleasant feeling that can be resulted from pain associated with chest tube removal. Administration of pain killer medications is associated with side effects such as respiratory distress, nausea, itching and gastrointestinal bleeding [4]

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Conclusion