Effect of Warm Therapy and Topical Anesthetic Cream on the Pain of Patients under Hemodialysis during Arteriovenous Fistula Needling

Transcription

1 Vol.128 (Healthcare and Nursing 2016), pp Effect of Warm Therapy and Topical Anesthetic Cream on the of Patients under Hemodialysis during Arteriovenous Fistula Needling Eun Sook Jeong 1, Hye Young Ahn 2*, Ji Eun Lee 3 1 Department of Nursing, Eulji University Hospital 2,3 College of Nursing, Eulji University 771 Beon-gil 77, Gyeryong-ro, Jung-gu, Daejeon34824, Korea * Corresponding Author: ahanaya@eulji.ac.kr Abstract. This study is intended to be utilized as nursing intervention for pain relief of hemodialysis patients by discovering the effect of warm therapy and topical anesthetic cream on patients under hemodialysis. As result, during the arteriovenous fistula needling of patients under hemodialysis in accordance with non-treatment, the application of warm therapy, and the application of topical anesthetic cream, there was a significant difference in subjective pain (F=16.891, p<.001). During the arteriovenous fistula needling of patients under hemodialysis in accordance with non-treatment, the application of warm therapy and the application of topical anesthetic cream, there was a significant difference in objective pain (F=20.180, p<.001). Through this study, warm therapy and topical anesthetic cream are deemed to be suitable to be utilized as nursing intervention for pain relief. Keywords: Hemodialysis Patient, Warm Therapy, Topical Anesthetic Cream, 1 Introduction In Korea, the number of end-stage renal disease patients undergoing renal replacement therapy, such as transplant or hemodialysis, is approximately 70,000 as of Of them, the number of those receiving hemodialysis is 48,531 or 69% [1]. In hemodialysis, which is carried out 2 to 3 times a week and lasts 3-4 hours in general, gauge needles are inserted for arteriovenous (AV) fistula, so most patients on hemodialysis report pain during the procedure [2,3]. Repeated pain, can lead to serious consequences, such as noncompliance to hemodialysis, so active patient management, such as assessment and intervention of symptoms and evaluation of applied intervention, is required [4,5]. Patients undergoing hemodialysis endure such pain as they believe AV fistula needling is an inevitable procedure required for treating their diseases. Therefore, Hemodialysis unit nurses must pay attention to pain of such patients and provide active interventions to reduce their pain. ISSN: ASTL Copyright 2016 SERSC

2 The purpose of this study is to identify compare the effects of warming therapy and topical anesthetic cream in relieving AV fistula needling-induced pain of the patients undergoing hemodialysis 3 times a week regularly. 2 Methods 2.1. Design This study is a one-group pretest-posttest research with the repeated measures design 2.2. Samples The study period went from August to September, 2013 and subjects were patients with chronic renal failure receiving hemodialysis regularly at E university hospital s hemodialysis unit Procedure Before starting the study, the approval from the Institutional Review Board (IRB) was obtained and the study subjects gave their informed consent. In the first week of the study, the subjects underwent AV fistula needling with no experimental intervention, as usual. In the second week, they applied the 1L PVC saline solution bag on the expected AV fistula needling site for 20 minutes. The third week was assigned as the washing phase in which no experimental treatment was provided to reduce carryover effects. In the fourth week, the subjects themselves applied a topical anesthetic cream and put an adhesive medical tape (Tegaderm TM ) on the needling site an hour before the AV fistula procedure. Before the AV fistula needling, no treatment, warm therapy, and topical anesthetic cream were applied per each group, and the subjects were asked to self-report degrees of subjective pain before and after the AV fistula needling. Their objective pain levels before and during the needling were assessed by clinical nurses. Such processes were carried out in all three hemodialysis sessions of each week excluding the third week Measurements The visual analogue scale (VAS) was used to measure subjective pain the subjects feel during AV fistula and the pain behavior checklist was used to measure objective pain [6]. The higher the score is the higher level of pain the subject felt. 64 Copyright 2016 SERSC

3 2.5 Data analysis For collected data analysis, SPSS 21.0 was used. One way ANOVA was used for pretreatment homogeneity test and repeated measures of ANOVA was used to analyze mean differences in pain among treatments. 3 Results 3.1. Homogeneity test for dependent variables Before AV fistula needling, the three groups were homogenous in subjective pain, objective pain. <Table1> Table 1. Homogeneity test for dependent variables before AV fistula (N=33) Variable No Treatment Warm Therapy Mean±SD Mean±SD Mean±SD Anesthetic Cream F p Subjective Objective.06±.35.21±.78.06± ±.36.12±.48.06± Effects of warm therapy and topical anesthetic cream on hemodialysis patient s pain during AV fistula needling Subjective pain the patients on hemodialysis feel during AV fistula needling showed significant differences per treatment (F=16.891, p<.001): no treatment was ±1.87; warm therapy was -3.75±1.89; and topical anesthetic cream was ±1.36. Objective pain also differed significantly per treatment (F=20.180, p<.001) with no treatment showing -1.85±1.92, warm therapy -.99±1.14, and topical anesthetic cream -.40±.99. <Table 2> Copyright 2016 SERSC 65

4 Table 2. Comparison of effects of no treatment, warm therapy and topical anesthetic cream on pain Variable Category (1 st Week) No Treatment (2 nd Week) Warm Therapy (4 th Week) Anesthetic Cream F p Subjective Objective 1 st 2 nd 3 rd (1-3) 1 st 2 nd 3 rd (1-3) Mean±SD Mean±SD Mean±SD -5.48± ± ± ± ± ± ± ± ± < ± < ± < ± < ± ± ± ± ± ± ± ± ± < ± ± ± < Conclusion This study has confirmed the effectiveness of warm therapy and topical anesthetic cream in pain relief and their potential as a nursing intervention that can be provided to hemodialysis patients. Warm therapy, an affordable, easy-to-use nonpharmacological intervention, which was applied in the form of a warm water bag, was helpful in reducing patients pain. Application of topical anesthetic cream, a pharmacological intervention, however, gives cost burden to patients and is not suitable for the patients finding it uncomfortable to use pharmacological treatment for a longtime. Therefore, providing warm therapy and tropical anesthetic cream in parallel is the most effective nursing intervention that helps relieve pain of hemodialysis patients during AV fistula needling. We believe that using warm therapy and topical anesthetic cream in parallel in clinical nursing practices can constitute an effective nursing intervention clinical nurses can provide for patients on hemodialysis. 66 Copyright 2016 SERSC

5 References 1. The Korea Society of Nephrology registration committee.: Current Renal Replacement Therapy in Korea, Hekelman, F.P., Ostendarp, C.A.: Nephrology Nursing: Perspectives of Care. McGraw- Hill Companies, New York (1979) 3. Yang, S.H., Shon, Y.H., Paik, H.J., Won, J.S., Yoo, J.H., Jeon, M.Y., et al.: Basic Nursing II. Hyunmoonsa, Seoul (2009) 4. Buhse, M.: Efficacy of EMLA Cream to Reduce Fear and Assosicated with Interferon Beta-la Injection in Patient with Multiple with Sclerosis. Journal of Neuroscience Nursing. 38, (2006) 5. Curtin, R.B., Bultman, D.C., Thomas-Hawkins, C., Walters, B.A., Schatell, D.: Hemodialysis Patients' Symptom Experiences: Effects on Physical and Mental Functioning/Commentary and Response. Nephrology Nursing Journal. 29, 562 (2002) 6. Park, J.: The Effect of Cutaneous Stimulation on AV Fistula Puncture of Hemodialysis Patients. Taehan kanho The Korean nurse. 33, (1993) Copyright 2016 SERSC 67