Background: patients who have chest tubes removal (CTR) following cardiac surgery are often experience a variety of discomfort, so that relaxation technique using slow deep breathing (SDB) exercise may be effective to minimize and alleviate their pain intensity. Aim of the study: this study was conducted to assess the effect of relaxation technique on pain intensity during chest tube removal following cardiac surgery through the following;(1) assess medical data and pain intensity of patients with chest tube following cardiac surgery, (2) implement relaxation technique using slow deep-breathing exercise during chest tube removal (3) evaluate the effect of relaxation technique using SDB on pain intensity among the patients during chest tube removal following cardiac surgery. Design: A quasi-experimental design (study and control groups) was utilized to achieve the aim. Setting: This study was conducted at cardiothoracic surgical intensive care unit at Cardiac Academy affiliated at Ain Shams University. Sample: A purposive subject of (136) critical ill adult patients, subdivided into two groups (study and control). Tools: Data was collected using three tools 1) Patients' interviewing questionnaire .2) Numeric Rating Scale (NRS). 3) Relaxation Technique observational checklist. Results: The present study revealed that pain intensity during CTR was significantly alleviated among the study group compared to the control group. Conclusion:The results of this study concluded that, level of patient's performance in the study group improved after the relaxation technique intervention (This supported the first hypothesis). Also, relaxation technique had a positively significant effect regarding alleviating pain intensity for the study group of patients during chest tube removal following cardiac surgery compared with the control group (This supported the second hypothesis). Recommendations: The importance of applying slow deep breathing exercise combined with described analgesic for all patients during chest tube removal following cardiac surgery to alleviate their pain.

Background: Central venous catheters (CVCs) are vascular infusion tools utilized for studying hemodynamic variables, dialysis, administration of medication, and nutrition. Catheter related blood stream infection (CRBSI) is a complication of central venous catheter (CVC) use. Central venous catheter-related infection (CVC-RI) is considered a common cause of increased morbidity, mortality, and medical care costs in intensive care units (ICUs). Aim of the study: to assess nurses' performance regarding infection control measures for patient with central line in critical care unit. Research design: A descriptive exploratory design was utilized.

Ventilator associated pneumonia (VAP) is a serious complication in critically ill patients; it can prolong intubation, increase intensive care unit and hospital length of stay, and increase mortality to twice the level of patients who do not develop VAP .Ventilator bundle was a group of evidence based practices that when implemented together for all patients on mechanical ventilation will result in dramatic reductions in the incidence of VAP. Aim of the study: Assessing nurses' perception regarding ventilator associated pneumonie bundle. Design: A descriptive exploratory design wasutilized. Setting: The study was carrier out in critical care units (surgical ICU, general ICU & CCU) at El Fayoum Universityz Hospitals. Study subjects:convenience sample of 40 nurses were included in the study. Data collection tools: Data were obtained through five main tools; demographic data tool, nurses' knowledge questionnaire, nurses' observational checklist, nurses' perception questionnaire and factors affecting nurses' perception questionnaire. Results: Three quarter of the study nurses had unsatisfactory knowledge and more than three quarters of them had incompetent level of practice regarding VAP bundle. About two thirds of the studied nurses hadnegative perception regarding VAP bundle. There were many factors affecting nurses' perception regarding VAP bundle as; nurses' related factors, health setting related factors and patients' relatedfactors. There was statistically significant difference between the nurses' perception, level of knowledge and practice regarding VAP bundle. As well there was statistically significant difference between the nurses' perception regarding ventilator associated pneumonia bundle and theirlevel of knowledge and practice. Recommendations: Designing in-service training and educational program to improve nurses' knowledge and practice regarding VAP bundle. The study should bereplicated on large sample& in different hospitals setting in order to generalize the results.

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