Effectiveness of Cryotherapy on Arteriovenous Fistula Puncture related Pain among Patients on Hemodialysis in selected Hospital at Mehsana District

 

Dr. Dayalal Patidar¹, Mr. Kaushal Patidar², Ms. Amita parmar³

¹Principal, Joitiba College of Nursing, Bhandu, Dist: Mehsana

²HOD, Medical Surgical Department, Joitiba College of Nursing, Bhandu, Dist: Mehsana

³MSc Nursing Student, Joitiba College of Nursing, Bhandu, Dist: Mehsana

 

ABSTRACT:

Background: Chronic renal failure is a devastating medical, social, and economic problem for both patients and their families in India. Hemodialysis (HD) is the most frequently used RRT with the arteriovenous fistula (AVF) being the gold standard for vascular access in HD patients. Aims and Objective: To determine the pain during Arteriovenous fistula puncturing among experimental group & control group. To evaluate the effectiveness of cryotherapy on pain during arteriovenous fistula puncture among experimental group. To determine the post test pain scores among hemodialysis in experimental &control group. To find out the association of pain with selected demographic variables in control and experimental group. Methods- The data were collected from 60 patients by “Non-Probability Convenient” sampling technique with the use Numerical rating scale for subjective pain assessment. and one group pretest posttest design was used. Results: Study show that out of 60 subjects in 30 experimental group, 10(33.3%) belongs to the age group between 28 -37 years, Regarding sex group majority 20(66.7%) were males, Regarding the educational status,10(33.3%) had primary education, 20(67.7%) were having less than 1year of duration of illness,17(56.7%) undergoes 11-15 times dialysis per month. and out of 30 Incontrol group 11(36.7%) belongs to the age group between 38-47 years, 21(70%) were male, 11(36.7%) had primary education, 13(43.3%) were having less than 1 year of duration of illness,15(50%) undergoes 11-15 times dialysis per month. Inexperimental group, majority in pre test 16 (53.3%) reported severe pain, after intervention of Cryotherapyin post test 20 (66.7%) reported mild pain, in control group, majority in pre test 16(53.3%) reported moderate pain, without intervention of Cryotherapy in post test reported mild pain 15 (50%). reveals that in experimental group the pretest mean was 6.57 and posttest mean was 2.93. The pre test standard deviation was 1.63 and the posttest standard deviation was 1.23. The mean difference was 1.63 and the obtained t-value was 16.7 which is significant at 0.001 level. Hence, the stated hypothesis was accepted. In control group the pretest mean was 6.3 and posttest mean was 5.9. The pretest standard deviation was 1.58 and the posttest standard deviation was 1.52. The mean difference was 0.40 and the obtained t-value was 4.397 which is not significant. Hence the stated hypothesis was accepted. Conclusion: cryotherapy was effective in reducing the AVF puncture related pain among clients undergoing hemodialysis.

 

 

 

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.¹

 

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.²

 

Chronic Renal Failure is a devastating medical, social, and economic problem for both patients and their families in India. Most Chronic Kidney Disease patients reporting to tertiary care centers in India are in the final stage where renal replacement therapy is the only option at that stage. Hemodialysis is the most frequently used renal replacement therapy and ArterioVenous Fistula is the “GOLD STANDARD” for vascular access in hemodialysis patients.³

 

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.⁴

 

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.⁵

 

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.⁶

 

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.⁷

 

Everyone has experienced some type or degree of pain, yet the concept of pain is difficult to communicate. The experience of pain is complex, involving emotional, and cognitive components. Pain control is important because pain can affect appetite, sleep, energy, ability to do things. Pain is considered as the 5^th vital sign. The recommended hierarchy of 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, biofeedback, cryotherapy, hot application, music therapy, laughter therapy, touch therapy etc.⁸

 

Pain inflicted by the insertion of large cannulae into the ArterioVenous Fistula is a significant cause of concern for both children and adults on regular hemodialysis. Although ArterioVenous Fistula puncturing causes pain, local anesthesia is not frequently used due to concerns of vasoconstriction, burning sensation, scaring, and infection. In India there are 700 dialysis centers with a total of 4,000 dialysis machines predominantly in the private sector. There are around 20,000 patients undergoing dialysis at these centers per month.⁹

 

NEED OF THE STUDY:

‘Pain is such an uncomfortable feeling that even a tiny amount of it is enough to ruin every enjoyment’.

 

According to WHO, worldwide 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.¹⁰

 

In India, the projected number of deaths due to Chronic Kidney Disease will rise from 3.78 million in 1990 to an expected 7.63 million in 2020. The treatment modalities for End Stage Renal Disease are hemodialysis, peritoneal dialysis and renal transplantation.¹¹

 

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.¹³

STATEMENT OF THE PROBLEM:

Effectiveness of cryotherapy on arteriovenous fistula puncture related pain among patients on hemodialysis in selected hospital at Mehsana district.

 

OBJECTIVE:

1.     To determine the pain during Arteriovenous fistula puncturing among experimental group & control group.

2.     To evaluate the effectiveness of cryotherapy on pain during arteriovenous fistula puncture among experimental group.

3.     To determine the post test pain scores among hemodialysis in experimental &control group.

4.     To find out the association of pain with selected demographic variables in control & experimental group.

 

HYPOTHISIS:

H0.    There will be no significant difference between pretest and posttest score regarding effect of cryotherapy at 0.05 level of significance.

H1.    There will be a significant reduction on ArterioVenous Fistula puncture pain among patients on hemodialysis who receive cryotherapy at 0.05 level of significance.

 

MATERIAL AND METHODS:

Quasi-experimental research (Non randomized control group design) one group pre test post test design and Numerical pain rating scale was used to assess the effectiveness of cryotherapy among arteriovenous fistula puncture related pain among hemodialysis patient The data were collected from 60 “Non-Probability Convenient” sampling technique were used.

 

RESULTS:

Demographic data was analyzed using frequency and percentage. Frequencies, percentage, mean, median, mean percentage and standard deviation was used to determine the knowledge score. The ‘t’ value was computed to show the effectiveness of cyotherpay and chi-square test was done to determine the Association between the level of AV Fistula puncture related pain among clients undergoing hemodialysis with their selected demographic variables.

 

Finding related to demographic data

Highest percentage in the demographic data including that most of the clients with Arteriovenous Fistula puncture related pain were between 28- 37 years, male sex, undergone primary education, having duration of illness less than 1 years and undergoes 11-15time dialysis per month.

 

Finding related to pre and post test pain score:

The data showed that, in the Inexperimental group, majority in pre test 16 (53.3%) reported severe pain, after intervention of Cryotherapyin post test 20 (66.7%) reported mild pain. in control group, majority in pre test 16 (53.3%) reported moderate pain, without intervention of Cryotherapy in post test reported mild pain 15 (50%).

 

Finding related to effectiveness of cryotherapy:

Table 1:

Sl. No	Standard deviation	Group	Mean	Mean difference	t- value
	1.63 1.23	Experimental group: Pre Test Post Test	6.57 2.93	3.64	16.7***

***significant at p<0.001 level.

 

Finding related to association between pretest knowledge score of adolescents with selected demographic variables:

There is no significant association between the frequency of dialysis per month and AVF puncture related of pain among clients undergoing hemodialysis.

 

The findings demonstrated that there was no significant association between pretest knowledge scores with selected demographic variables. It was interpreted that the pretest knowledge score regarding vector borne disease among adolescents were not influenced by the demographic variables.

 

CONCLUSION:

The main conclusion from this present study is that most of the hemodialysis patients with AVF puncture pain in experimental group had moderate and severe pain in pretest and mild and moderate pain in post test. This shows the imperative need to understand the purpose of cryotherapy technique regarding reduction of AVF puncture related pain among clients undergoing hemodialysis and it will improve the quality of life which includes the stability in physiological, psychological vocational and lifestyle aspects

 

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Received on 03.06.2019         Modified on 24.06.2019

Accepted on 17.07.2019       ©A&V Publications All right reserved