The Effect of Facilitated Tucking on the Pain Intensity Induced by Chest Tube Removal in Infants

BACKGROUND: Pain associated with chest tube removal is a major problem for patients who undergo open heart surgery. Because this pain is short-lived, timing the administration of pharmacological agents for pain relief is difficult and is therefore done inconsistently. OBJECTIVE: To examine the effect of music as an intervention for pain relief during chest tube removal after open heart surgery. METHODS: In an experimental design, 156 subjects (mean age, 66 years; 69% men) were randomly assigned to 1 of 3 groups: control, white noise, or music. All subjects preselected the type of music they preferred hearing. Ten minutes before the chest tube was removed, the patient's heart rate and blood pressure were measured, the patient rated pain intensity by using a numeric rating scale, and the prerecorded audiotape of music was begun. The patients rated their pain again immediately after chest tube removal and 15 minutes later. Physiological variables were assessed every 5 minutes until 15 minutes after the chest tubes were removed. RESULTS: Self-reported pain intensity, physiological responses, and narcotic intake after chest tube removal did not differ significantly among the 3 groups. CONCLUSIONS: Although the findings were not statistically significant, most subjects enjoyed listening to the music, and therefore the use of music as an adjuvant to other therapies may be an appropriate nursing intervention.

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Appropriately Timed Analgesics Control Pain Due to Chest Tube Removal

American Journal of Critical Care ◽

10.4037/ajcc2004.13.4.292 ◽

2004 ◽

Vol 13 (4) ◽

pp. 292-302 ◽

Cited By ~ 37

Author(s):

Kathleen Puntillo ◽

S. Jill Ley

Keyword(s):

Pain Intensity ◽

Chest Tube ◽

Sensory Information ◽

Double Blind Study ◽

Procedural Information ◽

Tube Removal ◽

Intravenous Morphine ◽

Chest Tube Removal ◽

Intravenous Ketorolac ◽

Pain Distress

• Background Pain during chest tube removal can be moderately to severely intense and distressful to patients. Little evidence-based research has guided clinicians in attempts to alleviate such pain.• Objective To test pharmacological and nonpharmacological interventions to alleviate pain during chest tube removal in cardiac surgery patients.• Methods Four interventions were tested in 74 patients in a randomized, double-blind study: (1) 4 mg intravenous morphine and procedural information; (2) 30 mg intravenous ketorolac and procedural information; (3) 4 mg intravenous morphine plus procedural and sensory information; and (4) 30 mg intravenous ketorolac plus procedural and sensory information. Analgesics were administered to correspond to peak effect, and scripted information was provided. Pain intensity and pain distress were measured before analgesic administration, immediately after chest tube removal, and 20 minutes later. Pain quality was measured immediately after chest tube removal. Level of sedation was measured before and 20 minutes after chest tube removal. Repeated-measures analyses of variance were used to test differences among groups over time.• Results Pain intensity, pain distress, and sedation levels did not differ significantly among groups. However, procedural pain intensity (mean 3.26, SD 3.00) and pain distress (mean 2.98, SD 3.18) scores for all were low. Patients remained alert, regardless of which analgesic was administered.• Conclusions If used correctly, either an opioid (morphine) or a nonsteroidal anti-inflammatory (ketorolac) can substantially reduce pain during chest tube removal without causing adverse sedative effects. Thus, clinicians may choose among several safe and effective analgesic interventions during chest tube removal.

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Effects of interpleural bupivacaine on pleural chest tube removal pain: a randomized controlled trial

American Journal of Critical Care ◽

10.4037/ajcc1996.5.2.102 ◽

1996 ◽

Vol 5 (2) ◽

pp. 102-108 ◽

Cited By ~ 23

Author(s):

KA Puntillo

Keyword(s):

Pain Intensity ◽

Normal Saline ◽

Chest Tube ◽

Repeated Measures ◽

Controlled Trial ◽

Control Group ◽

Double Blind ◽

Repeated Measures Design ◽

Tube Removal ◽

Chest Tube Removal

BACKGROUND: Moderate to severe pain associated with the removal of pleural chest tubes is poorly controlled with opioids. New methods are needed to manage the pain associated with this procedure. OBJECTIVES: To compare the effects of interpleural injections of 0.25% bupivacaine without epinephrine to those of normal saline on chest tube removal pain in cardiothoracic surgery patients. METHODS: A randomized, double-blind, placebo-controlled trial was used, with a repeated measures design. Pain intensity and distress were measured before, immediately after, and 1 hour after chest tube removal. Pain sensations and affect were evaluated immediately after chest tube removal. The experimental group (n = 21) received bupivacaine and the control group (n = 20) received normal saline. RESULTS: In both groups pain intensity and distress scores were significantly higher at the time of chest tube removal than immediately before or 1 hour after. No significant differences in pain intensity, distress, sensation, or affect scores were found between the two treatment groups. The 13 patients who received intramuscular ketorolac an average of 3.5 hours before the procedure, independent of the study design, had significantly lower pain intensity scores at the time of chest tube removal than the 26 who did not. CONCLUSIONS: These data demonstrate that chest tube removal pain is of moderate to severe intensity and that pleural chest tube injections of bupivacaine were not effective in decreasing chest tube removal pain. However, the decrease in pain associated with the administration of ketorolac warrants future study.

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Cold application for pain and anxiety reduction following chest tube removal : A systematic review and meta-analysis

10.21203/rs.3.rs-608013/v1 ◽

2021 ◽

Author(s):

Chia-Te Chen ◽

Heng-Hsin Tung ◽

Yen-Chin Chen ◽

Jiun-Ling Wang ◽

Sheng-Han Tsai ◽

...

Keyword(s):

Systematic Review ◽

Pain Intensity ◽

Skin Temperature ◽

Chest Tube ◽

Meta Analysis ◽

Anxiety Reduction ◽

Cochrane Library ◽

Tube Removal ◽

Cold Application ◽

Chest Tube Removal

Abstract Background and Objective: Data on the effects of cold application on reducing pain and anxiety after chest tube removal (CTR) are inconsistent. This study aimed to conduct a systematic review and meta-analysis to evaluate the effects of cold application on pain and anxiety reduction after CTR.Methods: We searched six databases, including Embase, Ovid Medline, Cochrane Library, Scopus, the Index to Taiwan Periodical Literature System, and Airiti Library, to identify relevant articles up to the end of February 2021. We limited the language to English and Chinese and the design to randomized controlled trials (RCTs). All studies were reviewed by two independent investigators. The Cochrane Collaboration’s tool was used to assess the risk of bias, and Review Manager 5.4 was used to conduct the meta-analysis.Results: Ten RCTs with 623 participants were included in the meta-analysis. The use of cold application could effectively reduce immediate pain and had persistent effects on pain after CTR. There were significant effects of cold application on reducing anxiety. The meta-regression showed that a drop in skin temperature to the 13°C target of cold application was significantly more effective for the immediate reduction in pain intensity compared with receiving up to 20 minutes target of cold application.Conclusion: Cold application is a safe and easy-to-administer nonpharmacological method with immediate and persistent effects on pain and anxiety relief after CTR. In particular, skin temperature drops to the 13°C target of cold application were effective for immediate reduction of pain intensity following CTR.

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Autologous Blood Pleurodesis: What Is the Optimal Time Interval and Amount of Blood?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1727129 ◽

2021 ◽

Author(s):

Alessio Campisi ◽

Andrea Dell'Amore ◽

Yonghui Zhang ◽

Zhitao Gu ◽

Angelo Paolo Ciarrocchi ◽

...

Keyword(s):

Chest Tube ◽

Autologous Blood ◽

Optimal Time ◽

Time Interval ◽

Air Leak ◽

Increased Risk ◽

Tube Removal ◽

Blood Patch ◽

Prolonged Air Leak ◽

Chest Tube Removal

Abstract Background Air leak is the most common complication after lung resection and leads to increased length of hospital (LOH) stay or patient discharge with a chest tube. Management by autologous blood patch pleurodesis (ABPP) is controversial because few studies exist, and the technique has yet to be standardized. Methods We retrospectively reviewed patients undergoing ABPP for prolonged air leak (PAL) following lobectomy in three centers, between January 2014 and December 2019. They were divided into two groups: Group A, 120 mL of blood infused; Group B, 60 mL. Propensity score-matched (PSM) analysis was performed, and 23 patients were included in each group. Numbers and success rates of blood patch, time to cessation of air leak, time to chest tube removal, reoperation, LOH, and complications were examined. Univariate and multivariate analysis of variables associated with an increased risk of air leak was performed. Results After the PSM, 120 mL of blood is statistically significant in reducing the number of days before chest tube removal after ABPP (2.78 vs. 4.35), LOH after ABPP (3.78 vs. 10.00), and LOH (8.78 vs. 15.17). Complications (0 vs. 4) and hours until air leak cessation (6.83 vs. 3.91, range 1–13) after ABPP were also statistically different (p < 0.05). Air leaks that persisted for up to 13 hours required another ABPP. No patient had re-operation or long-term complications related to pleurodesis. Conclusion In our experience, 120 mL is the optimal amount of blood and the procedure can be repeated every 24 hours with the chest tube clamped.

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“Chest Tube” Removal after Liver Transgression

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2011.10.010 ◽

2012 ◽

Vol 23 (2) ◽

pp. 275 ◽

Cited By ~ 6

Author(s):

Chris Hegarty ◽

Jan F. Gerstenmaier ◽

David Brophy

Keyword(s):

Chest Tube ◽

Tube Removal ◽

Chest Tube Removal

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The use of cold therapy, music therapy and lidocaine spray for reducing pain and anxiety following chest tube removal

Complementary Therapies in Clinical Practice ◽

10.1016/j.ctcp.2018.12.001 ◽

2019 ◽

Vol 34 ◽

pp. 179-184 ◽

Cited By ~ 3

Author(s):

Yeşim Yaman Aktaş ◽

Neziha Karabulut

Keyword(s):

Music Therapy ◽

Chest Tube ◽

Cold Therapy ◽

Tube Removal ◽

Chest Tube Removal ◽

Lidocaine Spray

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Technique for chest tube removal

ASVIDE ◽

10.21037/asvide.2017.226 ◽

2017 ◽

Vol 4 ◽

pp. 226-226

Author(s):

Kyung Soo Kim

Keyword(s):

Chest Tube ◽

Tube Removal ◽

Chest Tube Removal

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Chest tube removal after cardiac surgery

Critical Care Nurse ◽

10.4037/ccn1997.17.1.34 ◽

1997 ◽

Vol 17 (1) ◽

pp. 34-38 ◽

Cited By ~ 6

Author(s):

SC Thomson ◽

S Wells ◽

M Maxwell

Keyword(s):

Cardiac Surgery ◽

Quality Of Care ◽

Length Of Stay ◽

Chest Tube ◽

Chest Tubes ◽

Tube Removal ◽

Chest Tube Removal

Prompt remove of chest tubes by RNs has allowed earlier and more aggressive ambulation of our patients and, along with other interventions, has decreased length of stay by 1.5 days while improving quality of care. Proper education, both didactic and clinical, is the key component in preparing RNs to safely and effectively perform this procedure.

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Safety of early discharge with a chest tube after pulmonary segmentectomy

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa097 ◽

2020 ◽

Vol 58 (3) ◽

pp. 613-618

Author(s):

Feichao Bao ◽

Natasha Toleska Dimitrovska ◽

Shoujun Hu ◽

Xiao Chu ◽

Wentao Li

Keyword(s):

Chest Tube ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Early Discharge ◽

Air Leak ◽

Tube Removal ◽

Prolonged Air Leak ◽

Life Threatening ◽

Chest Tube Removal ◽

Hospital Days

Abstract OBJECTIVES Early removal of chest tube is an important step in enhanced recovery after surgery protocols. However, after pulmonary resection with a wide dissection plane, such as pulmonary segmentectomy, prolonged air leak, a large volume of pleural drainage and the risk of developing empyema in patients can delay chest tube removal and result in a low rate of completion of the enhanced recovery after surgery protocol. In this study, we aimed to assess the safety of discharging patients with a chest tube after pulmonary segmentectomy. METHODS We retrospectively reviewed a single surgeon’s experience of pulmonary segmentectomy from May 2019 to September 2019. Patients who fulfilled the criteria for discharging with a chest tube were discharged and provided written instructions. They returned for chest tube removal after satisfactory resolution of air leak or fluid drainage. RESULTS In total, 126 patients underwent pulmonary segmentectomy. Ninety-five (75%) patients were discharged with a chest tube postoperatively. The mean time to chest tube removal after discharge was 5.6 (range 2–32) days, potentially saving 532 inpatient hospital days. Overall, 90 (95%) patients experienced uneventful and successful outpatient chest tube management. No life-threatening complications were observed. No patient experienced complications resulting from chest tube malfunction. Five (5%) patients experienced minor complications. Overall, all patients reported good-to-excellent mobility with a chest tube. CONCLUSIONS Successful postoperative outpatient chest tube management after pulmonary segmentectomy can be accomplished in selected patients without a major increase in morbidity or mortality.

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