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

Abstract

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.

The effect of virtual reality glasses on reducing pain during chest tube removal

“…The fact that the VAS score decreased more in favor of the intervention group 10 min after the procedure was found to be statistically significant (2.75 versus 1.45 and p=0.017). The study by Soydan and Uğraş [32] reported that the VAS scores before ChTR decreased significantly in the intervention groups concurrently before and after the ChTR procedure. The same study found that the highest pain score of patients in the control group was during the procedure, and the VAS scores 15 min after the procedure were significantly higher in the control group than in the intervention groups.…”

The effect of cold application on pain during the chest tube removal: A meta-analysis

“…[15] In many studies, the experimental group was exposed to the cold application for a concrete time, while in a few studies, the skin temperature of the patients was expected to decrease to 13 to 13.6°C. [2,11,16] No intervention was made on the control group patients, and only the routine procedure was conducted. The pain severity was recorded before and immediately after CTR in all studies.…”

“…A meta-analysis was performed with 16 studi es [1,2,4,[11][12][13][15][16][17][27][28][29][30][31][32][33] and the combined effect showed a larger effect (n=1,246; d=-1.265; 95% CI: -1.67, -0.86) (Figure 2). The cold application was, therefore, effective in reducing pain during CTR (p<0.001).…”

“…In addition to medical treatments such as paracetamol [2] and remifentanil, [7,8] the effects of complementary therapies, alone or in combination with medical treatments, have been studied for relieving pain during CTR. [4] Some of these methods are ice pack, [9][10][11] acupressure, [12] relaxation, [13] gel pack, [14] intravenous paracetamol combination with cold gel packet, [2] cold compress and local anesthesia, [15] cold application and aromatherapy with lavender oil, and cold application in combination with lavender oil inhalation, [16] and cold application combined with a breathing exercises technique. [17] Cold desensitizes sensory nerve terminals and reduces the transmission of pain.…”

“…In previous studies, different cold application techniques such as cold gel packs, cooling packs, gel peds, ice pack gels, and ice bags/ice cubes are applied to the area surrounding the chest tubes by covering them with sterile gauze. [1,2,4,[11][12][13][15][16][17] Nevertheless, the results of the studied on cold application during CTR vary, and no consistently satisfactory approach has become established in clinical practice. In this meta-analysis, we, therefore, aimed to investigate the effect of cold application on CTR-related pain compared to conventional analgesic care.…”