THE EFFECT OF CRYOTHERAPY ON ARTERIOVENOUS FISTULA PUNCTURE PAIN AMONG PATIENTS ON HEMODIALYSIS IN SELECTED HOSPITAL AT TRICHY Dissertation submitted to THE TAMILNADU DR. M.G.R MEDICAL UNIVERSITY CHENNAI IN PARTIAL FULFILLMENT OF REQUIREMENT FOR THE AWARD OF DEGREE OF MASTER OF SCIENCE IN NURSING APRIL 2016
70
Embed
THE EFFECT OF CRYOTHERAPY ON ARTERIOVENOUS …repository-tnmgrmu.ac.in/2859/1/3001222301411702Kavipriya S.pdfthe effect of cryotherapy on arteriovenous fistula puncture pain among
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
THE EFFECT OF CRYOTHERAPY ON ARTERIOVENOUS FISTULA PUNCTURE PAIN
AMONG PATIENTS ON HEMODIALYSIS IN SELECTED HOSPITAL AT TRICHY
Dissertation submitted to
THE TAMILNADU DR. M.G.R MEDICAL UNIVERSITY
CHENNAI
IN PARTIAL FULFILLMENT OF REQUIREMENT
FOR THE AWARD OF DEGREE OF
MASTER OF SCIENCE IN NURSING
APRIL 2016
THE EFFECT OF CRYOTHERAPY ON ARTERIOVENOUS FISTULA PUNCTURE PAIN
AMONG PATIENTS ON HEMODIALYSIS IN SELECTED HOSPITAL AT TRICHY
Certified that this is the bonafide work of
Reg. No: 301411702, MEDICAL SURGICAL NURSING,
THANTHAI ROEVER COLLEGE OF NURSING, PERAMBALUR
COLLEGE SEAL : SIGNATURE : Prof. R.PUNITHAVATHI, M.Sc (N)., Principal, Thanthai Roever College of Nursing, Perambalur, Tamil Nadu.
Dissertation submitted to
THE TAMILNADU DR. M.G.R MEDICAL UNIVERSITY CHENNAI
IN PARTIAL FULFILLMENT OF REQUIREMENT
FOR THE AWARD OF DEGREE OF
MASTER OF SCIENCE IN NURSING APRIL 2016
THE EFFECT OF CRYOTHERAPY ON ARTERIOVENOUS FISTULA PUNCTURE PAIN
AMONG PATIENTS ON HEMODIALYSIS IN SELECTED HOSPITAL AT TRICHY
Approved by the Dissertation Committee On : ___________________________
Research Guide :_________________________ Prof.R.PUNITHAVATHI, M.Sc (N)., Principal, Thanthai Roever College of Nursing Perambalur, Tamil Nadu.
Clinical Specialty Guide :_________________________ Prof.V.J.ELIZABETH, M.Sc (N)., Vice-Principal, Thanthai Roever College of Nursing, Perambalur,Tamil Nadu.
Dissertation submitted to
THE TAMILNADU DR. M.G.R MEDICAL UNIVERSITY CHENNAI
IN PARTIAL FULFILLMENT OF REQUIREMENT
FOR THE AWARD OF DEGREE OF
MASTER OF SCIENCE IN NURSING
APRIL 2016
INTERNAL EXAMINER EXTERNAL EXAMINER
DECLARATION
I, 301411702 here by declare that this dissertation entitled A STUDY
TO ASSESS THE EFFECTIVENESS OF CRYOTHERAPY ON
ARTERIOVENOUS FISTULA PUNCTURE PAIN AMONG
PATIENTS ON HEMODIALYSIS IN SELECTED HOSPITAL AT
TRICHY has been prepared by me under the guidance and direct supervision
of Prof. V.J. ELIZABETH M.Sc(N)., Vice Principal, Thanthai Roever
College of Nursing, Perambalur, as requirement for partial fulfillment of
M.Sc Nursing degree course under The Tamilnadu Dr. M.G.R. Medical
University, Chennai . This dissertation had not been previously formed and
this will not be used in future for award of any other degree or diploma. This
dissertation represents independent original work on the part of the candidate.
Place : Perambalur, 301411702,
Date : April 2016. II Year M.Sc (N) Student,
Thanthai Roever College of
Nursing, Perambalur.
ACKNOWLEDGEMENT
I am the Lord your God who leads you by the way you should go.
Isa 48:17
I praise and thank LORD ALMIGHTY JESUS CHRIST for his
abundant grace and blessings showered upon me throughout the study .
I express my sincere gratitude to Dr. K. Varadharaajen, BA.,BL.,
Chairman and Managing Trustee, Thanthai Roever College of Nursing,
Perambalur for providing me an opportunity to pursue this Post Graduate
programme in this esteemed institution.
I express my sincere thanks and appreciation to
Prof. R. Punithavathi, M.Sc. (N)., Principal Thanthai Roever College of
Nursing , for laying the foundation of scientific research and rendering the
needed corrections , suggestions, support and love throughout this study .
I would like to express my gratitude to my guide
Prof. V.J. Elizabeth., M.Sc. (N)., Vice Principal Thanthai Roever College
of Nursing who gave me valuable suggestions, guidance and encouragement
which shaped and fashioned my study and spared her precious time to
complete my study.
I thank all faculty of Thanthai Roever College of Nursing for their
timely advice, encouragement and support.
I am grateful to all the experts for their sincere efforts in validating my
tool.
I express my words of appreciation to Mr. Venkataraman M.Phil.,
Statistician, for his guidance and suggestions in the statistical analysis of the
data.
I wish to express my thanks to the MANAGING DIRECTOR of
Gastro Care Hospital in trichy for granting permission to conduct the study.
My gratitude to all the subjects who enthusiastically participated in
carrying out the research project. I appreciate their keen interest, patience and
cooperation evinced for successful completion of the study.
My gratitude to Mrs.V.Bakkiyalakshmi M.L.I.S.M.Phil librarian of
Thanthai Roever College of Nursing and all the library staffs of
Tamilnadu Dr. M.G.R. Medical University, Chennai for their support and
guidance in procuring the literature related to the study.
It is my immense pleasure to express my heartiest gratitude to my family
members, Mr. Singaram my dear father for his moral support and priceless
encouragement, Mrs. Shanthi my dear mother for her kind unconditional
help, love and encouragement from birth till now. I am extremely thankful to
my sister Ms.Christi and my husband Mr.Mahesh for support and
motivation throughout my career.
I thanks to all my friends for their constant support,
co-operation and mutual aid during the study.
As a final note I, the investigator, owe a deep sense of gratitude to all
those who have directly or indirectly contributed to the successful completion
of this endeavour.
THE EFFECT OF CRYOTHERAPY ON ARTERIOVENOUS FISTULA PUNCTURE PAIN
AMONG PATIENTS ON HEMODIALYSIS IN SELECTED HOSPITAL AT TRICHY
ABSTRACT
INTRODUCTION: Hemodialysis impacts quality of life of patients with
chronic kidney disease. Although Arteriovenous Fistula have the lowest
complaints of apprehension and fear of painful needling. cutaneous
stimulation referred to as peripheral technique , describes any form of
stimulation of the skin with the goal of pain relief.
OBJECTIVE: To assess the effectiveness of cryotherapy on ArterioVenous
Fistula puncture pain among patients on hemodialysis .
METHOD: True experimental posttest only control group design was
adopted for this study. Sixty patients were recruited by simple random
sampling method. Experimental group (n=30) received cryotherapy for 8
minutes in contralateral arm and Control group (n=30) no intervention.
ArterioVenous Fistula puncture pain was assessed by numerical pain scale.
RESULTS: The findings revealed that the post test mean score
ArterioVenous Fistula puncture pain was 2.63 ± 1.27 in the experimental
group and 7.06±
significant at p<0.001.
DISCUSSION: The study concluded that the level of ArterioVenous Fistula
puncture pain among patients on hemodialysis was reduced after receiving
cryotherapy.
TABLE OF CONTENTS
CHAPTER NO TITLE PAGE NO
I INTRODUCTION 1-7
Need for the study 3
Statement of the problem 3
Objectives of the study 5
Research Hypotheses 5
Operational Definitions 5
Assumption 6
Delimitations 7
Projected outcome
7
II REVIEW OF LITERATURE 8-16
Studies related to cryotherapy
Studies related effectiveness of
cryotherapy on arteriovenous fistula
puncture pain
Conceptual Framework
8
11
14
III METHODOLOGY 17-22
Research approach 17
Research design 17
Variables 17
Setting of the study 18
Population 18
Sample size and sampling technique 18
Description of tool 19
CHAPTER NO TITLE PAGE NO
Pilot study 20
Data Collection Procedure 20
Plan for data analysis 20
IV DATA ANALYSIS AND
INTERPRETATION
23-35
V DISCUSSION 36-37
VI SUMMARY 38-43
Major findings of the study 39
Implications 40
Recommendations & Conclusion 42
REFERENCES 44-49
ANNEXURES i-ix
LIST OF TABLES
TABLE
NO
TITLE PAGE NO
1 Frequency and percentage distribution of
demographic variables among Patients on
hemodialysis
.
24
2 Frequency and percentage distribution of post test
level of ArterioVenous Fistula puncture pain
among patients on hemodialysis in experimental
and control group
29
3 Comparison of post test mean score of
ArterioVenous Fistula puncture pain among
patients on hemodialysis between the experimental
and control group
31
4 Association of post-test level of ArterioVenous
Fistula puncture pain among patients on
hemodialysis and their selected demographic
variables in experimental group
32
5 Association of post-test level of ArterioVenous
Fistula puncture pain among patients on
hemodialysis and their selected demographic
variables in control group
34
LIST OF FIGURES
FIGURE NO TITLE PAGE NO
1 Conceptual framework
16
2 Schematic representation of research
methodology.
22
3 Percentage distribution of age among patients on
hemodialysis
26
4 Percentage distribution of gender among patients
on hemodialysis.
26
5 Percentage distribution of duration of chronic
kidney disease among patients on hemodialysis
27
6 Percentage distribution of frequency of dialysis
per week among patients on hemodialysis
27
7 Percentage distribution of duration of
ArterioVenous Fistula among patients on
hemodialysis
28
8
Percentage distribution of post test level of
ArterioVenous Fistula puncture pain among
patients on hemodialysis in experimental and
control group. . 30
LIST OF ANNEXURES
ANNEXURE NO TITLE PAGE NO
I Letter seeking Permission for research purpose i
II
Validation ii
III Evaluation criteria checklist for validation. iii
IV List of Experts opinion for content validity of
research tool iv
V Content Validity Certificates v
VI Certificate of English editing vi
VII Informed Consent vii
VIII Data collection tool viii
CHAPTER I
INTRODUCTION
Chronic kidney disease is increasingly recognised as a global public
health problem for both patients and their families in India because of their
associated adverse clinical outcomes, poor quality of life and high health care
cost.
World Health Organization estimates that the diseases of the kidney
and urinary tract contribute to over 8.5 lakhs and over 15 million disability-
adjusted life years. It is estimated that approximately one lakh new patients
develop ESRD in India annually. The ESRD incidences has been reported to
be 160 -232 per million population. The number is increasingly globally at a
rate of 8% every year. It is estimated that only 10-20% of ESRD patient in
India continue long term renal replacement therapy (RRT). Chronic Kidney
Disease is 12th leading cause of death and 17th cause of disability in the
world.
Chronic kidney disease patients mostly reporting to tertiary care
centres in India are in the final stage where renal replacement therapy is the
only option at the stage. Hemodialysis is the most frequently used renal
replacement therapy. Arterio venous fi
for vascular access in Hemodialysis patients .
Hemodialysis can be done at a dialysis centre or at home . when done
in a centre, It is generally done three times a week and takes between three
and five hours per session . Home dialysis is generally done three to seven
times per week and take three and ten hours per session.
Pain during arteriovenous fistula cannulation remains a common
problem in hemodialysis patients. Pain inflicted by the insertion of large
cannulae into the arterio- venous fistula is a significant cause of concern for
both children and adults on regular hemodialysis. patients undergoing
hemodialysis are repeatedly exposed to pain from approximately 300
punctures per year to their Arterio venous fistula. pain is an unpleasant
sensory and emotional experience associated with physiological and
psychological responses.
Although Arterio venous fistula puncturing causes pain, local
anaesthesia is not frequently used due to concerns of vasoconstriction,
burning sensation, scaring and infection. Alleviation of this pain might
improve their acceptance of the procedure and thus , their quality of life.
The recommended hierarchy of pain management should consist of
non-pharmacological treatment as first , then drugs and if necessary surgery.
There are various non-pharmacological methods that can help to relieve the
pain perception such as distraction, biofeed back, cryotherapy, hot
application, touch therapy . These methods are superficial forms of treatment
that the nurse in practice is qualified to perform. Nursing effort should be
made to assess and manage acute pain inflicted by insertion of needle in
Arterio venous fistula among hemodialysis patients.
Cryotherapy is greek word
s are exposed to
extreme cold for short duration . cryotherapy which supplied over the
intestine meridian relieve pain in the shoulder and arm, rigidity of neck,
scapula and eye disease . This pathway is located on the back side of the hand
between the thumb and the index finger , it is bilateral and begins in the
surface of the skin runs to ends in large intestine. So procedural pain is one of
the primary types of pain which the health care team encounter in their daily
practice.
NEED FOR THE STUDY
According to WHO, world wide the number of receiving renal
replacement therapy is estimated at more than 1.4 million with incidence
growing by approximately 8% annually. In India there are 700 dialysis
centers with a total of 4000 dialysis machine are available . The cost of each
hemodialysis session in India varies from Rs.250 , in government hospital and
Rs. 2000 in some private hospitals.
Arterio venous fistula have a much better access patency and survival
than do venous catheters or graft. In CKD, 90.6% population had an AV
fistula and 9.4% had an AV graft. During hemodialysis patient may
experience some of the related complaints are puncturing pain, muscle
cramps, itching , sleep problem, infection. The needles used are 14 to 16
gauges and are inserted into the fistula or graft to obtain vascular access. The
insertion of large bore needle in to Arterio venous fistula causes significant
pain.
Figueiredo A E, et al Conducted research into pain perception with
arteriovenous fistula cannulation in patients with end stage renal failure
(ESRF) undergoing haemodialysis.
three different HD sessions. Pain was considered moderate to severe during
AVF needling than that of buttonhole technique.
Crespo Montero R,et al evaluate the effect of needle bevel position
on the degree of pain and damage to the skin covering the vein, in an
ArterioVenous Fistula puncture. It was concluded that Arterio Venous fistula
puncture with the bevel facing downward significantly reduces the degree of
pain and the skin lesion at the point of puncture, without increasing the
number of punctures.
The renal patients experience pain during ArterioVenous Fistula
which extends throughout renal replacement therapy (RRT) it, so the
investigator choose non pharmacological cutaneous stimulation against
ArterioVenous fistula puncture pain.
An experimental study was conducted on the effect of cutaneous
stimulation on Arterio venous fistula puncture pain of hemodialysis patients.
Randomly 45 patients were selected and intervention of cryotherapy was
given for10 minutes. This results showed that the subjective pain scores of
Arterio venous fistula puncture pain in experimental group with cutaneous
stimulation were lower compared to the control group.
Nurses as advocator for patients are obligated to minimize the
emotional and physical effects of painful procedures. The investigator felt
that nurses in these departments can make major contribution to the patients
by reducing pain in the fistula site most effective proven interventions.Hence
the researcher is interested in evaluating the simple , cost effect, easy to
administer intervention cryotherapy to reduce ArterioVenous Fistula puncture
pain .
STATEMENT OF THE PROBLEM
A Study to assess the effectiveness of Cryotherapy on Arterio
Venous Fistula puncture pain among patients on hemodialysis in selected
hospital, at Trichy.
OBJECTIVES
1. To assess the level of ArterioVenous Fistula puncture pain among
patients on hemodialysis.
2. To assess the effectiveness of cryotherapy on reduction of
ArterioVenous Fistula puncture pain among patients on
hemodialysis .
3. To find the association between post test level of ArterioVenous
Fistula puncture pain among patients on hemodialysis and their
selected demographic variables.
HYPOTHESES
H1:There will be a significant reduction on ArterioVenous Fistula
puncture pain among patients on hemodialysis who receive cryotherapy .
H2: There will be a significant association between the post test level
of ArterioVenous Fistula puncture pain and their selected demographic
variables of patients on hemodialysis who receive cryotherapy .
OPERATIONAL DEFINITIONS
Effectiveness
It refers to the outcome of cryotherapy in terms of reduction of Arterio
Venous Fistula puncture pain.
Cryotherapy
A cryotherapy is a cold application done with ice cubes wrapped in a
glove on the web between the thumb and index finger of the hand not having
Arterio Venous Fistula (contralateral arm) started 6 minutes before the
puncturing procedure and continued 2 minutes after puncture .
Arterio Venous Fistula
An Arterio Venous Fistula is the surgically created connection of a
vein and artery usually in the forearm or upper arm ,to create an access to the
vascular system for hemodialysis as a treatment of chronic renal failure .
Hemodialysis
Refers to removal of waste product from the blood of a patient with
acute or chronic renal failure by means of a dialyser machine.
Arterio Venous Fistula Puncture Pain
ArterioVenous Fistula puncture pain is an expressed unpleasant
subjective sensory and emotional experience of the patients associated with
arteriovenous fistula puncture which is measured by standard numerical pain
scale.
ASSUMPTIONS 1. Patients on hemodialysis experience pain during arteriovenous