Effect of Dry Cold Application on Pain Perception and Ecchymosis among Patients Receiving Low Molecular Weight Heparin

 

Miss. Shijila. S1, Mrs. Jean Tresa. J2*

1Quality Control Executive, NIMS, Trivandrum

2Associate Professor, Department of Medical Surgical Nursing, College of Nursing, Sri Ramakrishna Institute of Paramedical Sciences, Coimbatore.

*Corresponding Author Email: jeantresa@gmail.com

 

ABSTRACT:

The study to assess the effect of dry cold application on pain perception and ecchymosis among patients receiving low molecular weight heparin was conducted using true experimental posttest only control group design. Using total enumerative sampling technique 25 samples were selected and randomly assigned to experimental   group (n=13) and the control group (n=12). Dry cold application was given for 3 minutes on the LMWH injection site for the experimental group. Pain perception and ecchymosis was assessed using numerical pain rating scale and transparent ruler scale respectively. Using unpaired ‘t’ test, the effect of dry cold application on pain perception was analyzed immediately after withdrawing the needle, after 4 hours and 8 hours(t = 2.205, 2.827 and 2.912 respectively, df = 23, p < 0.05) and ecchymosis was analyzed after 48 hours and 72 hours (t = 2.129 and 2.118 respectively, df = 23, p < 0.05). Hence it is concluded that application of dry cold is effective in reducing the level of pain perception and ecchymosis among patients receiving low molecular weight heparin.

 

KEYWORDS: Dry cold application, pain perception, ecchymosis.

 

INTRODUCTION:

Health is the functional efficiency of a living organism(Webster, 1913). Health systems need to be strengthened to deliver better care for peoples. Primary care is the only access to medical treatment and use of low-technology interventions(United National Report, 2007). Subcutaneous low molecular weight heparin (LMWH) is frequently prescribed for stroke, deep vein thrombosis and other cardiovascular disorders. Low molecular weight heparin (LMWH) is a class of medication used as an anticoagulant. They are administered subcutaneously in fixed doses once or twice daily (Melba and Priyalatha, 2009).

 

NEED FOR THE STUDY:

Approximately 318 patients receive Injection LMWH per year in a selected hospital, Coimbatore. Subcutaneous administration of heparin is a frequently performed nursing intervention(Batra, 2014). Pain and Ecchymosis are the common side effects associated with LMWH. Dry cold application is a simple and inexpensive therapy which has been accepted for an effective non pharmacologic intervention for pain management and progression of ecchymosis (Melba and Priyalatha, 2009).

 

STATEMENT OF THE PROBLEM:

Effect of Dry Cold Application on Pain Perception and Ecchymosis among Patients Receiving Low Molecular Weight Heparin at Selected Hospital, Coimbatore.

 

 

OBJECTIVES:

·      To assess the pain perception and ecchymosis among patients receiving low molecular weight heparin.

·      To evaluate the effect of dry cold application on pain perception and ecchymosis among patients receiving low molecular weight heparin.

Hypothesis:

H1  : There will be a significant difference in the level of pain perception between the experimental group and control group after dry cold application among patients receiving low molecular weight heparin.

H2  : There will be a significant difference in the size of ecchymosis between the experimental group and control group after dry cold application among patients receiving low molecular weight heparin.

 

METHODOLOGY:

Quantitative research approach was adopted for the study with  true experimental posttest only control group design. The study was conducted in the general and special wards of Sri Ramakrishna Hospital, Coimbatore. Total Enumerative Sampling technique was used to select the samples. All the 25 patients who met the sampling criteria were randomly assigned to experimental group (n=13) and control group (n=12) using lottery method. The independent variable of the study was dry cold application. The dependent variables of the study were pain perception and ecchymosis among patients receiving low molecular weight heparin. The demographic profile, clinical profile, numerical rating scale and transparent ruler scale were framed based on the expert opinion and the supportive literatures. Ethical consent was obtained from the institutional ethical committee. Informed consent was obtained from each study participant. Dry cold application was given for 3 minutes on LMWH injection site to the experimental group. Injection LMWH was administered subcutaneously to the experimental and control group by the researcher. Posttest was done to assess the pain perception immediately after withdrawing needle, 4 hours, and 8 hours by using numerical pain rating scale and ecchymosis was assessed 48 hours and 72 hours after the day of injection by using transparent ruler scale.

 

 

 

 

RESULTS:

Table I: Effect of Dry Cold Application on Pain Perception among Patients receiving Low Molecular Weight Heparin in the Experimental Group and Control Group

S. No

Pain Perception

Group

Mean

SD

Mean difference

't' value

1.

Immediately after withdrawing needle

Experimental Group

0.439

0.555

1.422

2.205*

Control Group

1.861

2.155

2.

After 4 Hours

Experimental Group

0

0

0.294

2.827*

Control Group

0.294

0.359

3.

After 8 Hours

Experimental Group

0

0

0.099

2.912*

Control Group

0.099

0.119

*Significant at 0.05 level

 

 

 

 

Table 2: Effect of Dry Cold Application on Ecchymosis among Patients Receiving Low Molecular Weight Heparin in the Experimental Group and Control Group

S. No

Ecchymosis

Group

Mean (cm2)

SD

Mean difference

't' value

1.

48 hours

Experimental Group

0.003

0

0.066

2.129*

Control Group

0.069

0.108

2.

72 hours

Experimental Group

0.001

0

0.108

2.118*

Control Group

0.109

0.175

*Significant at 0.05 level

 

 

 

Unpaired 't' test was used to analyze the effect of dry cold application on pain perception among patients receiving LMWH in experimental and control groups. Level of pain perception was assessed immediately after withdrawing needle, it was identified that, the mean score and standard deviation of experimental group was 0.439 and 0.555 respectively and control group was 1.861 and 2.155 respectively with the mean difference of 1.422. Calculated ‘t’ value was 2.205, which was greater than the table value (tv= 2.07, df=23) at 0.05 level of significance. Pain perception was assessed after 4 hours, it was identified that, the mean score and standard deviation of experimental group was 0 and control group 0.294 and 0.359 respectively with the mean difference of 0.294. Calculated ‘t’ value was 2.827, which was greater than the table value (tv= 2.07, df=23) at 0.05 level of significance. Pain perception assessed after 8 hours, it was identified that, the mean score and standard deviation of experimental group was 0 and the control group was 0.099 and 0.119 respectively with the mean difference of 0.099. Calculated ‘t’ value was 2.912, which was greater than the table value (tv= 2.07, df=23) at 0.05 level of significance. Hence it shows there is a significant difference in the level of pain perception among patients receiving LMWH immediately after withdrawing needle, after 4 hours and after 8 hours in the experimental and control group. Unpaired  't' test was used to analyze effect of dry cold application on ecchymosis among patients receiving LMWH in experimental and control groups. Size of ecchymosis was assessed 48 hours after the day of injection, it was identified that, the mean score and the standard deviation of experimental group was 0.003 and 0 respectively and control group was 0.069 and 0.108 respectively with the mean difference of 0.066. Calculated ‘t’ value was 2.129, which was greater than the table value (tv= 2.07, df=23) at 0.05 level of significance. Ecchymosis was assessed 72 hours after the day of injection, it was identified that, the mean score and the standard deviation of experimental group was 0.001 and 0 and control group was 0.109 and 0.175 respectively with the mean difference of0.108. Calculated ‘t’ value was 2.118, which was greater than the table value (tv= 2.07, df=23) at 0.05 level of significance. Hence it shows there is a significant difference in the size of ecchymosis among patients receiving LMWH in 48 hours and 72 hours after the day of injection.

 

MAJOR FINDINGS:

From the present study, it was found that the dry cold application was effective in reducing the level of pain perception and ecchymosis among patients receiving low molecular weight heparin.

 

CONCLUSION:

The patients receiving LMWH experience pain and develop ecchymosis. The study was conducted to identify the effect of dry cold application on pain perception and ecchymosis among patients receiving low molecular weight heparin. This study proves that the dry cold application is effective in reducing pain perception and ecchymosis among patients receiving low molecular weight heparin. Therefore the dry cold application can be used as a measure in reducing injection LMWH induced pain perception and ecchymosis.

 

REFERENCES:

1.     Batra, G. (2014). Application of ice cube prior to subcutaneous injection of heparin in pain perception and ecchymosis of patients with cardiovascular problems. The Nursing Journal of India, 4, 155-159. Retrieved from website: http://www.unboundmedicine.com/medline/25799797

2.     Kuzu, N., and Ucar, H. (2001). Effect of local dry cold application on the occurrence of bruising, haematoma and pain at the injection site of subcutaneous low molecular weight heparin injections. International Journal of Nursing Studies, 38(1), 51-59. Retrieved from website: http://www.researchgate.net/publication/12190938

3.     Melba, C., and Priyalatha. (2009). Effect of dry cold application on the occurrence of bruising and pain at the subcutaneous injection site of LMWH. Asian Journal of Cardiovascular Nursing, 22, 10-15.

4.     Polit, D. F., and Beck, C. T. (2013). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). New Delhi: Wolters Kluwer.

5.     Sharma, S. K. (2012). Nursing research and statistics. India: Elsevier.

6.     United National Report. (2007).Neurological Disorders. Retrieved from website:http://www.un.org/21689

7.     Varghese, C., Indarjit, W., Sharma, Y. P., and Kaur, S.(2006). Effect of moist ice pack application to the prevention and reduction of pain, bruise and hematoma on the site of subcutaneous heparin injection. Nursing and Midwifery Research Journal,2(4), 139-148.Retrieved fromwebsite: http://www.ncbi.nlm.nih.gov/pubmed/22893265

8.     Webster, S. (1913). Dictionary Definition of Health. Retrieved from website: http://pnwf.org/health

 

 

 

 

Received on 26.06.2016                Modified on 10.07.2016

Accepted on 17.07.2016                © A&V Publications all right reserved

Asian J. Nur. Edu. and Research.2016; 6(4): 503-505.

DOI: 10.5958/2349-2996.2016.00094.X