Nurses’ knowledge and experience related to short peripheral venous catheter extravasation

Background: The majority of hospitalized patients receive a Peripheral Venous Catheter (PVC) in the course of their treatment. Extravasation injury is a serious complication of intravenous treatment. Objective: This cross-sectional survey designed study aims to investigate nurses’ knowledge and experience related to short peripheral venous catheter extravasation. Method: The study sample included 145 nurses working in a university hospital in the west of Turkey. A questionnaire developed in accordance with the literature was used for data collection. The data were assessed by frequency and proportions. Results: Of the nurses included in this study, 26.2% reported they had experienced extravasation injury in a patient; 74.5% said they had received no instruction in the management of extravasation during their in-service training program; and 85.5% stated they did not keep a record of extravasation. 89.7% of the nurses reported infused medications as a cause of extravasation, and 81.4% reported catheter sites as a cause. Among the medications reported by the nurses as causing extravasation: 89.7% reported contrast agents; 84.8% TPN solutions; 71.0% cytotoxic agents; and 65.1% mannitol. The symptoms of extravasation reported by nurses included: swelling (97.9%), redness (97.2%), pain (92.4%), rise in temperature (65.5%), and ulceration (60.0%). In responding to the occurrence of extravasation, interventions reported by the nurses included: stopping the flow of fluid (98.6%), elevation (89.7%), cold application (76.6%), and aspiration of drug (40.7%). Conclusion: Based on these results, it is recommended that guidelines are developed for the management of extravasation, that periodic in-service training programs are provided and that observational studies are carried out into the administration of vesicant drugs.

Effect of different cold application materials on pain during chest tube removal: three-arm randomized controlled clinical trial

Background: Chest tube causes severe pain during removal because it attaches to the endothelium in the chest cavity. Objectives: This study aimed to determine the effectiveness of cold application with ice pack and gel pad in the control of pain experienced during chest tube removal. Methods: The sample of prospective, parallel three-arm (1:1:1), randomized controlled clinical trial consisted of 180 patients in two experimental groups (ice pack/gel pad) and one control group. The primary outcome was effect of cold application materi- als on severity of pain during chest removal. Secondary outcomes were duration of cold application and analgesic requirements of the patients. Results: The study found that the cold application using either of the materials reduced the severity of pain and the need for analgesics after the removal of chest tube compared to the control group (p<0.05). But cold application with ice pack allowed the skin to drop to the temperature effective in pain control in a shorter time than gel pad application (p<0.05). Conclusions: Despite entirely covering the area around the chest tube, the gel pad was more disadvantageous than ice pack in pain control due to the longer duration of cold application. Keywords: Chest tube removal; cold application; pain; nurse.

A three-dimensional model of transient bioheat transfer in the lower extremity during cryotherapy

The purpose of this research was to create a computational model of the human thigh undergoing cryotherapy. The tissue temperatures were measured for five cold pack temperatures of −8°C, −4°C, 0°C, 4°C, and 8°C in addition to six different time intervals of cold application and ice removal. The depth of cold penetration and duration of local tissue cooling were investigated at 10 points during 30 min of application and 7 h of post-application. The model was created in CATIA, using a mid-axial cut of the human thigh MRI without pathology. After validation by the available clinical data, this research applied the finite-volume discretization method to solve bioheat transfer equations. A 16°C decrease in the cold pack temperature reduced the tissue temperatures located 1 and 2 cm below the fat by almost 3.34°C and 1.4°C, respectively, after 30 min of cold application. It took the tissues 10–15 min to start cooling down, and the temperature reached its plateau after 100 min. Thirty minutes of cold application declined the superficial tissue and deep tissue temperatures near the bone by 22.59°C and 0.48°C, respectively. Intense cryotherapy led to an insignificant change in the deep tissue temperature at 2 cm and deeper below the fat tissue. After ice removal, tissues continued cooling down for about 8 min until 40 min, depending on the tissue depth. This study proposed a 100-min cold therapy with 10 min of ice removal to optimize tissue cooling.

Effectiveness of Ice Pack Application on Level of Pain and Bruise Formation among Patients Receiving Subcutaneous Low Molecular Weight Heparin at Selected Hospitals of City

Background: Bruising is one of the most common adverse events following administration of enoxaparin sodium, which can lead to unpleasant consequences such as reduced access to various sites for injection, reduced satisfaction of patients from treatment and care provided. Cold application is helpful for better management of these side effects which could be easily accessible and economical for the patients. Cold application appears to be cheaper and easily available. Aim: The purpose of this study was to identify the effectiveness of ice pack application on level of pain and bruise formation among patients receiving subcutaneous low molecular weight heparin. Method: Quasi experimental nonequivalent control group posttest only design was adopted. The population comprised of 60 patients receiving subcutaneous low molecular weight heparin from selected hospitals of Pune. Sample of the study were 60 patients receiving subcutaneous low molecular weight heparin patients selected by convenient sampling. The patients in experimental group were provided with ice pack application before receiving subcutaneous low molecular weight heparin to reduce the level of pain and bruise formation. Data was collected by using numerical pain scale, visual analog scale and transparent ruler scale. Result: The study findings showed that average numerical pain score in experimental group was 3.87 and 6.33 in control group. Bruise size was measured in cm. In experimental group Average bruise formation size was 0.0233 after 24 hours of injection, 0.1633 after 48 hours of injection and 0.1766 after 72 hours of injection compared to control group 0.2733 after 24 hours of injection, 0.3933 after 48 hours of injection and 0.4066 after 72 hours of injection. There is significant difference in mean scores of experimental and control group. Conclusion: The findings of the study shows that the ice pack application is effective in reducing the level of pain and bruise formation among patients receiving

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

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.