Chest Tube Removal: Efficacy of Cold Application and Breathing Exercises on Pain and Anxiety Level

Abstract

Context: Post-cardiothoracic surgical chest tube removal (CTR) is considered a painful technique and one of the most painful patients' experiences in the intensive care unit. Painkillers are the most prevalent method to relieve the pain, but the patient may not respond well and achieved complete relaxation. Regardless of scientific advances, no efficient action is possessed to decrease pain and anxiety because of it. Aim: This study aimed to investigate the efficacy of cold application and breathing exercises on pain and anxiety levels following chest tube removal. Methods: A quasi-experimental design (one group pre/post-test) was utilized to achieve the aim. This study was conducted in the Intensive Care Unit at the Cardio-Thoracic Academy Affiliated to Ain Shams University Hospital, Cairo. A Purposive sample included 60 patients undergoing cardiothoracic surgical procedures and having at least two chest tubes in place. Data were collected using three tools; a structured interviewing questionnaire, pain intensity assessment visual numeric scale, short-form McGill pain assessment questionnaire, modified comfort scale, and breathing exercise checklist. Results: This study revealed that patients suffer from severe pain before CTR without cold application and breathing exercise (61.7%), or with the application of them (66.7%), the pain level improved during removal as 80% of patients display no pain when using the cold application and breathing exercise that increased to 95% after 10-15 minute of removal compared to 8.3% when cold application and breathing exercise not used. Otherwise, the anxiety level decreased during CTR as 58.3% had mild anxiety level with cold application and breathing exercises compared to 38.3% had a very severe anxiety level. Mild anxiety level increased to 91.7% after 10-15 minutes of CTR compared to 16.7 % when CTR without application. Conclusion: Cold application and breathing exercises are useful for reducing patients' pain and anxiety levels associated with chest tube removal after cardiothoracic surgery. Encouraging critical care nurses to use cold application and breathing exercises as a nonpharmacological pain relief technique during chest tube removal was highly recommended.