| Abstract|| |
Purpose: The study aimed to determine the effects of cold alcohol compression on pain of preschoolers receiving an intravenous (IV) fluid infusion. Methods: In this quasi-experimental, four group study, 3–5-year-old children in the intervention groups (n = 20) received cold alcohol compression 1 min before IV insertion. The control group (n = 20) received conventional nursing care. The Children's Hospital of Eastern Ontario Pain Scale was used to assess pain intensity. The t-test was used to analyze pain. Results: The result indicated that the pain score of the experimental group was significantly lower than that of the control group (P < 0.01). Practice Implications: Cold alcohol compression is a time, cost-saving, and efficient method to reduce pain in preschoolers receiving the IV fluid infusion. Conclusion: Providing cold alcohol compression is the effective method which does not need intensive preparation.
Keywords: Cold alcohol compression, fear, intravenous fluid infusion
|How to cite this article:|
Wonginchan A, Thanasilp S, Rodcumdee B. Effects of cold alcohol compression on pain of preschoolers receiving intravenous fluid infusion. Ann Trop Med Public Health 2017;10:1169-73
|How to cite this URL:|
Wonginchan A, Thanasilp S, Rodcumdee B. Effects of cold alcohol compression on pain of preschoolers receiving intravenous fluid infusion. Ann Trop Med Public Health [serial online] 2017 [cited 2020 Feb 22];10:1169-73. Available from: http://www.atmph.org/text.asp?2017/10/5/1169/217511
| Introduction|| |
The intravenous (IV) fluid infusion is a common method used to balance body fluids and electrolytes as well as to administer medications.,, It is also a significant source of pain.,,, Pain is one of three principal causes of fear for preschooler clients receiving intravaginal insemination (IVI). Nowadays, pain is indicated as the “fifth vital sign” to monitor in the hospital. Reducing pain in pediatric patients is a great nurses role.
The painful experiences suffered by children continue to have an effect in the adult. It may cause an increasing reaction to pain and avoidance of medical procedures in later life.
The American Academy of Pediatrics and the American Pain Society recommend that pain should be reduced to a minimum or lessened, even in minor practices such as achieving IV access. Therefore, reducing pain that preschoolers experience in this procedure is imperative.,
Cold therapy is a nonpharmacological intervention often managed to reduce pain causes physiologic change mainly on a neurological response that has a direct effect on the gate mechanism in obstructing the pain sensory. It has been used effectively in many studies.,,
The gate control theory of pain  supports the usefulness of cold compression techniques to manage pain. Stimulation of large A-delta fibers by cold causes substantia gelatinosa in the dorsal horn of the spinal cord to close the gates to pain and decrease the transmission of pain impulses to the brain.
Before the IV insertion, 70% cotton ball alcohol is commonly used to disinfect the patient's skin. Performing compression with cold alcohol cotton balls seems to be a time-saving and cost-effective way of performing the IVI procedure. In previous studies, there is no evidence show if compression with cold alcohol cotton balls was convenient for IV insertion in preschoolers receiving IV fluids.
Therefore, this study investigates the effect of cold alcohol compression on pain in preschoolers receiving IV fluid transfusions. The research hypothesis is that preschoolers who receive cold alcohol compresses will experience lower pain levels than children who receive conventional care.
| Methods|| |
Design and sample
This study was a quasi-experimental, four group with posttest only design. It aimed to investigate the effect of providing concrete objective information plus cold alcohol compression in reducing fear in hospitalized preschoolers (3–5 years) receiving their first experience of IVI. Due to the possibility of problem in contamination of treatment, in the experimental and control groups, the 40 participants were determined by purposive sampling with matched pairs by gender.
Participants were selected by convenience sampling. They were those receiving their first experience of IV fluid infusion. The preschoolers had no diagnosis of emergency disease or diagnosis of mental retardation or delayed development [Figure 1]. They had no vision or hearing problems. They were also not receiving any topical anesthetic medication and were not in receipt of any opioid or sedatives or analgesic drugs during the previous 4 h previous to their first experience of IVI.
A plan for cold alcohol compression - the researcher developed this plan based on stress theory  which explores the threatening effects to personal psychological states. Gate control theory of pain  was used to reduce the severity of the threat [Table 1]. A manual for nurses using the intervention instruments. The cold alcohol cotton ball; the 70% cold alcohol solution cotton ball was refrigerated to −15°C for at least 1 h. A digital thermometer.
Instrument for data collection
Demographic data sheet - the participant's and mother's demographic and clinical data included age, diagnosis, education, and birth order. The assessment tool of pain was the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) scale. The CHEOPS is classified as an observation scale and was primarily developed to evaluate postoperative pain in small children. It can be used, however, to assess interventions for reducing pain and discomfort as well as for evaluating short and sharp pains. Its inter-rater reliability ranges from 0.90 to 0.99. In Thailand, Suraseranivongse, Santawat, Kraiprasit, Petcharatana, Prakkamodom, and Muntraporn translated and tested the CHEOPS scale. The study was designed to cross-validate a composite measure of the pain scales CHEOPS, objective pain scale, simplified for parent use by replacing blood pressure measurement with observation of body language or posture, Toddler Preschool Postoperative Pain Scale, and Face, Legs, Activity, Cry, Consolability in 167 Thai children aged 1–5.5 years. It was translated and tested for content, construct, and concurrent validity, including inter- and intra-rater reliabilities. Discriminative validity in immediate and persistent pain for the age groups ≤3 and >3 years was also studied. The children's behavior was videotaped before and after surgery, before analgesia had been given in the postanesthesia care unit (PACU) and on the ward. Four observers then rated pain behaviors from rearranged videotapes. The CHEOPS had acceptable content validity and excellent inter- and intra-rater reliabilities (intraclass correlation >0.9 and >0.8, respectively). Construct validity was determined by the ability to differentiate the group with no pain before surgery and a high pain level after surgery, before analgesia (P < 0.001). The positive correlations among all scales in the PACU and on the ward (r = 0.621–0.827, P < 0.0001) supported concurrent validity. Use of the kappa statistic indicated that the CHEOPS produced the best agreement with the routine decision to treat pain. The younger and older age groups both yielded a very good agreement in the PACU but only moderate agreement on the ward. Owing to the data from their study, the researchers recommend the CHEOPS as a valid, reliable, and practical tool.
In this study, the CHEOPS was used to rate pain scores from applying alcohol to the IV insertion area, IV insertion, strapping tape on the IV site, and swaddle cloth over the child's arm for supporting the needle. The test–retest reliability of the CHEOPS was 0.83–1.0.
Permission was obtained from the Khon Kaen University Ethics Human Research and the Khon Kaen Hospital Institute Review Board in Human Research, Thailand. The evaluation by the Institutional Ethics Committee found the research to be in compliance with ethical principles. Before conducting the research, the children and their parents were informed about the study using an information and consent form that explained the purpose, plan, and duration of the research.
Ten minutes before starting the infusion, the demographic questionnaire was completed by the parents of children in each of the two groups. The parents were asked the number of IV fluid infusions that the patient had received. Parents of children in the both groups were provided with conventional nursing care information. A video was recorded from applying alcohol to the IV insertion area, IV insertion, strapping tape on the IV site, and swaddle cloth over the child's arm for supporting the needle. Data were collected from every child on the first try. In all of the groups, parents accompanied their children during the procedure. The single-blind research assistant rated the occurrence of a given behavior from applying alcohol to the IV insertion area, IV insertion, strapping tape on the IV site, and swaddle cloth over the child's arm for supporting the needle.
Intravenous fluid infusion procedure
Providing conventional nursing care, nurse greeted, introduce herself and provided the information about the process, the necessity of IVI and talked through what would happen during the procedure to the mother and the preschool children. The nurse provided a maternal role during IVI including reassurance, advice, and activities. Preschoolers lay on while the nurse wrapped a waddled cloth around the preschoolers. The nurse took the preschoolers into a supine position. Then, she applying a 70% alcohol cotton ball on the skin and inserted the IV catheter. This took about 5 min.
Providing cold alcohol compression - the 70% alcohol solution cotton ball was cooled to −15°C for at least 1 h before the procedure. The nurse applied it onto the skin in a circle two inches in diameter. The cotton ball was reversed and compressed on the skin for 1 min before insertion of the IV needle.
The demographic data were presented as frequencies and percentages. The t-test was used for determining the differences in the pain scores between the control and experimental groups. The results were expressed with a 99% confidence interval and P < 0.01 was considered to be statistically significant.
| Results|| |
The majority of the participants were 3 years old (40%), education level was kindergarten 1 (47.5%), and birth order was 1st (40%). To prevent the influence of extraneous variables on dependent variables, the overall data were tested homogeneity. The result shows that the control and experimental groups were homogeneous in regard to age, education level, and birth order (P > 0.01).
The pain score for the experimental group was 7.15 (standard deviation [SD] = 1.76) and 10.05 (SD = 1.27) for the control group. It indicated that mean of pain in the experimental group was lower than that of the control group. Statistical testing was undertaken to support the effect of treatment on the dependent variable. The assumption of normality was met for a t-test. Thus, the appropriate statistic to determine the effective treatment for pain was the t-test. The result indicated that the pain score of the experimental group was significantly lower than the control group. It means that the pain level experienced by preschoolers who received cold alcohol compressions was lower than that of those who received conventional care.
[Table 2] showed that the pain levels in the experimental group are lower than the control group. Statistical testing was undertaken to assess the effect of treatment on dependent variables. The results show that there was a difference in pain levels between the experimental group (M = 7.15, SD = 1.76) and the control group (M = 10.05, SD = 1.27) (P < 0.01).
|Table 2: Mean and standard deviation of pain between experimental and control groups|
Click here to view
| Discussion|| |
The research objective was to examine the effect of cold alcohol compresses on pain in preschoolers receiving IV fluid infusions. The research hypothesis is that pain in preschoolers who receive cold alcohol compression is lower than those receive conventional care. The result of this study indicates that pain in preschoolers receiving cold alcohol compression 1 min before IV fluid infusion is lower than the conventional care [Figure 2]. It is consistent with the results of several studies of cold therapy on pain in various populations.,,
|Figure 2: Pain score of preschoolers according to the Children's Hospital of Eastern Ontario Pain scale|
Click here to view
This study result suggests that, consistent with the literature review, cold alcohol compression effects pain reduction. The positive finding supports the effectiveness of cold in decreasing pain during IV insertion. The reduction in pain could be explained by the following reasons. The reason of cold alcohol compression could reduce pain depends on reducing the threat of the pain receptor. The gate control theory of pain  supports the usefulness of cold compression techniques to manage pain. Stimulation of large A-delta fibers by cold causes substantia gelatinosa in the dorsal horn of the spinal cord to close the gates to pain and decrease the transmission of pain impulses to the brain.,
Pain is indicated as the “fifth vital sign” to monitor in the hospital. Reducing pain in pediatric patients is a great nurses role. The American Academy of Pediatrics and the American Pain Society recommend that pain should be reduced to a minimum or lessened, even in minor practices such as achieving IV access (the American Academy of Pediatrics, Committee on Psychosocial Aspects of Child, Family Health, Task Force on Pain in Infants, Children, and Adolescents, 2001).
This study indicated the effective method to reduce pain of IV access. This is the great pediatric nurse's role. The cold alcohol compression could reduce pain and used in various pediatric departments which provide IV insertion for preschoolers.
This study indicated that cold alcohol compression is an effective method to reduce pain in preschoolers receiving IVI. It is an appropriate method to use in pediatric department because of it is a save time, cost, and effective method.
| Conclusion|| |
The findings of this study have implications for scientific knowledge as nonpharmacological intervention to reduce pain using cold is typically employed in others contexts. Providing cold alcohol compression intervention with the gate mechanism reduces nerve impulses to the brain and eliminates pain perception from IV insertion. In nursing practice, pediatric nurses can enhance performance to reduce the pain of IV insertion in a pediatric patient. Providing cold alcohol compression is the effective method which does not need intensive preparation. It is a time- and cost-saving method which can use in every medical center. Pediatric nurses can provide this intervention for preschoolers receiving IV fluid infusion.
This research was supported by the Research Fund of the 90th Anniversary of Chulalongkorn University Scholarship, Thailand.
Financial support and sponsorship
This research was supported by the Research Fund of the 90th Anniversary of Chulalongkorn University Scholarship, Thailand.
Conflicts of interest
There are no conflicts of interest.
| References|| |
James SR, Nelson KA, Ashwill JW. Nursing Care of Children: Principles & Practice. 4th
ed. St. Louis: Missouri; 2013.
Lilly M. Practice in Children's Nursing Guidelines for Hospital and Community. Toronto, Ontario: Churchill Livingstone, Elservier, Mosby; 2010.
Wong DL. Whaley & Wong's: Nursing Care of Infants and Children. 8th
ed. St. Louis: Missouri; 2007.
Hughes T. Providing information to children before and during venepuncture. Nurs Child Young People 2012;24:23-8.
Kolk AM, van Hoof R, Fiedeldij Dop MJ. Preparing children for venepuncture. The effect of an integrated intervention on distress before and during venepuncture. Child Care Health Dev 2000;26:251-60.
Leahy S, Kennedy RM, Hesselgrave J, Gurwitch K, Barkey M, Millar TF. On the front lines: Lessons learned in implementing multidisciplinary peripheral venous access pain-management programs in pediatric hospitals. Pediatrics 2008;122 Suppl 3:S161-70.
Uman LS. Psychological Interventions for Needle-Related Procedural Pain and Distress in Children and Adolescent. (Doctoral), Dalhousie University. Halifax, Nova Scotia, ProQuest Dissertations and Theses; 2009.
Sadeghi T, Mohammadi N, Shamshiri M, Bagherzadeh R, Hossinkhani N. Effect of distraction on children's pain during intravenous catheter insertion. J Spec Pediatr Nurs 2013;18:109-14.
American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health; Task Force on Pain in Infants, Children, and Adolescents. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics 2001;108:793-7.
DeMore M, Cohen LL. Distraction for pediatric immunization pain: A critical review. J Clin Psychol Med Settings 2005;12:281-91.
Kennedy RM, Luhmann J, Zempsky WT. Clinical implications of unmanaged needle-insertion pain and distress in children. Pediatrics 2008;122 Suppl 3:S130-3.
Chaittapiwat Y. A Comparison of Pain Reduction Methods in Knee Replacement Patients: Using Cold Compression Before or Both Before and During Exercise on Continuous passive Motion Machine. Unpublished Master Thesis, Mahidol University, Thailand; 2003.
Koç M, Tez M, Yoldas O, Dizen H, Göçmen E. Cooling for the reduction of postoperative pain: Prospective randomized study. Hernia 2006;10:184-6.
Ruksrithong T. The Effect of Nursing Care to Relieve Pain and Parental Participation on Fear Among Preschoolers Receiving Intravenous Fluid Infusion. Unpublished Master Thesis, Chulalongkorn University, Thailand; 2011.
Melzack R, Wall PD. The challenge of measurement of pain in infants, children, and adolescents: From policy to practice. Phys Ther 1996;84:560-70.
Huether SE, Defriez CB. Pain, temparature regulation, sleep, and sensory function. Pathophysiology: The Biologic Basis for Disease in Adults and Children. 5th
ed. St. Louis: Mosby-Year Book; 2006.
Lazarus RS, Folkman S. Stress Appraisal and Coping. New York: Spriger; 1984.
Melzack R, Wall PD. Pain mechanisms: A new theory. Science 1965;150:971-9.
King S, Ellis A, Frey A. Assessing Children's Well-Being: A Handbook of Measures. Mahwah, N.J.: Routledge; 2004.
Suraseranivongse S, Santawat U, Kraiprasit K, Petcharatana S, Prakkamodom S, Muntraporn N. Cross-validation of a composite pain scale for preschool children within 24 hours of surgery. Br J Anaesth 2001;87:400-5.
Dawan P. A Comparison of Effects of Nursing Care Using Refrigerated Alcohol Compression and Distraction by Kaleidoscope to Repeat on Venipuncture Pain and Cooperation of School Age Children. Unpublished Master Thesis, Chulalongkorn University, Thailand; 2007.
Kaewnanthawat P. Effect of Pain Management Combined with Complementary Care Program on Acute Pain and Physiological Response in Patients With Cardiac Surgery. Chulalongkorn University, Bangkok; 2016.
Algren CL. Family-center care of the illness and hospitalization. In: Hockenberry MJ, Wilson D, editors. Wong's Nursing Care of Infants and Children. 8th
ed. Canada: Mosby Appleton & Lange; 2007. p. 1046-82.
Faculty of Nursing, Chulalongkorn University
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2]