a dy etultufi9tufluu Original Article

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fr kiYunrrfiasr low molecular weight heparinEffects of Ice Pack with Air Lock Technique Injection to prevent

Subcutaneous Bleeding and Pain in Coronary Artery Disease patients

That used Low Molecular weight Heparin Injection

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Tasana Luengsupaboon Dip in Nursing Science

Kannika Lysthong B.N.S.

Department of Nursing

Sawanpracharak Hospital

Nakhon Sawan

Sawanpracharak Medical Journal

Vol.e No.t January-April zorre-t I

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Effects of Ice Pack with Air Lock Technique Injection to Prevent Subcutaneous Bleeding and Pain inCoronary Artery Disease Patients That Used Low Molecular V\reight Heparin Iniection

4ruaRt:flRU-l : n'rrLfi nR1?vLfi o n a a n1fr fi ruri.:1u:vdLhi:u r:{ (petechiae) fi nm N LLn n ril.,l

riulor u frrh fl n d il n?u n il vlu;a fl av 63.8 dru rir-h a neiru fi nr*r yruio uav{qlgq

tY t, t A d u d

83.6 (P = 0.017) uri{rJrun{il6nurfi:cBr'unrrruriuilrorrads 23 + 1.2v t 9t, ' ia u d , a

nvLLuu uafln21rJl_l?unaern?unilflil:saLn?1iltauil?nrilas 2.7 i. 1.1

nuLtull (P = 0.031)

To study the effects of air lock injection technique with ice pack in

preventing subcutaneous bleeding and pain in acute coronary

syndrome patients who received low molecular weight heparin injection.

Coronary Care Unit and Female lnternal Medicare Ward, Sawanpracharak

Hospital.

Randomized clinical trial.

130 patients with acute coronary syndrome patients at Coronary Care

Unit and Medicine women unit Sawanpracharak hospital in November

2008 - April 2009.

Patients were randomized by interrupted time series and divided into

two groups. The control group (69 patients) used air lock injection

technique without icepack and the experimental group (61 patients)

used wifr air lock injection technique wih ice pack. Pain and subcutaneous

bleeding were recorded and compared. The data was analyzed using

Exact probability test and t - test with statistically significance at p < .05.

The petechiae rate were 63.8% in experimental group and 83.6%

in control group (P = 0.017). The pain score were 23 + 1.2 in

experimental group and 21 J t.t in control group( P = 0.031).

Using ice pack with air lock injection technique can decrease pain in

acute coronary syndrome patients who receive low molecular weight

heparin injection. but it cannot prevent subcutaneous bleeding.

Suhcutaneous bleeding, lce pack, Low molecular weight heparin, Pain

oountcnna,o

Subjects

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Abstract

Obiective

Setting

Design

Method

Results

Conclusion

Key words

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9raice pack ilu:aans ffi.8 (P = 0.017) tLgtnTLRFt

vpu rpu ra, echymosis, hematoma :? 8Jt1it?tu't Fl

A 6le/a v A j jLASAOAn tAi{?14U{?ty{U [[A3:cEl3[',]A'ttAaUn

a oea u & et Z,1\Ufl ',t?vLn O naa n Ln r.J?14u{ nT.t tt:n tuyt.l 2

r li r I v O r AvnaSJ[tJrrnnal.:nu ttacLun4il[{ ice packqqdud,fi:vd'unmelriuilanrafia e.s * t.z nyLruu

-h a* auanril.:m n ndrufrtlr'lfr ice pack fi :sriu nrrruq

diriuilrorroh:.t z.t * t.t FlvLLuu (p = 0.031)

;(m1:'t.tYt 3)

ad?ot:fu

n1:"[fr ice pack irrun]uunnfinnr:fior

u'r rLUU air lock tilar rur:nfl a.: riu nr:rfi nnrrsA 5lya vqy

' &ty auraaaaanLazu'lfiu{La nnil?tLt ice pack riam:r

n1:tnn petechiae Sasnv 83.6 rJlnn'jrndruq

Al atc, .!v a tyflLeJ[Z ice pack ilom:1n1Trnn :aunu 63.8A I u t dv o u aaqI\: LtFl n n1.l fl U0 u'hl tlU U 6'l nfU?'l1.:dn n UAs

a A Oqza uO u An1:tfl Frfil?vtaanaa n Lmanfi u{ tua nurusau Ir,,uYAlrutLnna1.,]nuuua1o[ua.,:elrtrn fl1 LMWHo61 9aA

Y]1 lfi rnnLaanaannl8Jd2un1{ I fla{:1{n1Ejt4tYY A I

Ln:aflnr 13.3-38.3 Lyr:1vEt't LMWH 'Jr.lnFlon1: ufi.,: pirr a.: rd a Brtuil.t fl l uIn u rflu

E

I

etoxoilnl:li ice pack i:ufirtrnnfinnt:6nuluuu air lock rdoilo.rffunrrr6oRrrsr6oooonldfiruriqrayaonrtlrirhJaalu{rl:al:nuooar6oofirloflriiunrt6ou'r Iow molecular weight heparin

-,A - - ) Effects of Ice Pack with'Air Lock Technique Iniection to Prevent Subcutaneous Bleeding and Pain inull 8 Quun I il.n.-tu u 2!!1 1g ,

anti-factor Xa utnvanti-factor ttXa fiaonqndri.,:rJ fr ffi arz a.: antith rom bi n I I I lfr r5rduvh'Ifr

n1?fl51{ thrombin frra.: n:rf,u heparino a rv A o

t

cofactor I I ?l',] Lfi u1l elo n1:?11.:1u?a.,: th rom bin.iAaav&tflilil'ln?u ann213J14unfla\:taan LtasflLthl

nl :yi'hnu? a { platelet factor t V yir'lfr nr: urfi Iay&-oogdao

n'l?t a{ Ln a nfl1 a{ T? tJl]{ Eht?]1 L?1 Ln:A tn a n Lu,6ir.: nr u rir n.,ral nilfr n3fl 1ra{ I gG-heparin

immune complex dnfi'la ttav fl1 ASAi-,, \4vv A u d a Y, yYl 9.ttl? u LFTTU a H1.-lao tuo{ El{il ilnfl u u{n1Tdi1.,:

thtmboxane 42 lurnsBrrdaor yir'lfrrfinfl1:Y u 6 a r cly 6

uu fl .l n1::2 tJ fl ufl a{ tn:n Laa n d\l rJa lfi n1:[?{vdv\,dvt..-^,e

ra-'rz o.: tfi a pr{r n.,:lrl d n fi? u ( 1 4' 1 8)

u o n a1 nfi n1:d YOYa ooya A0fr Er1 [?r'r La rJ?fi u{d1 }J1:fl n1 Lm rfl n la a n ao nOYA -r4v A d , &La zu?mu.,t LFt tua.lal nnlTLtn{t?ilarfl ra tJlutu? a.: fi u-.t fi1 n 5r m f.: ttfr ua vi'r.,: Lt?1? a { ?1 n a Ft

A & 'J a ua a A & |

ra 0 n n LU r fi rjd rJ x fi u.] 6 { a 3 fr .0 du ? o.,: rfi a r fi a't frAAdd,&ovzu?fi un Hi o il n1:Qn ar rjrufu fr ffi r"l.: a.:hJ o#r6ly 4 r \9v d aty[fi fi a o n taa a 9J o u LFI:Uu't n tou [Ftauo'la [n Ftd A OYa v

LtRl'lrLnonaan Lnr{'tfiu{gt'uJ}J't Collet ua3

n rur( 1 8 ) lfr fi n r*r 6 I rJo o-a d ri.,: r.r a oi a n r : r fi pr rd a n

aonlufrr-hfldtfiilrm LMWH t'{u'j1 qndza.:ur^'

' N 6, ytt a dQvLlt 3.t u1 fl ?tu [u rJ u? u Ly'l FI]1 flt.,: il a1 u et1 n n't't

ya@q

7s iJ druu-nfiaun'j1 45 fiInniru firl:s{hril uI: n nm a,r riula fi m a.: ua rfi a n :1 n ? 1 N r5?fl a.,l{nT:rir{n creatinine riaEln'ir so finfinirururfrado , .hv ofi.rlun{rufflfi ice pacr riu firirJrau^rrtufr.,:

6.:5aaa= gs.t :ruu'ie t 'Lu g za.:nairua1r-leEr

ltaaar st .t ) fiaruil1nn'i1 zs fl unvfirhrrhrilul:rrnmruriulafi na.,: fatlas zz.o neir.rdgqI A9 aY i a ty

[t |.fl ir:n pack tt{11']pltv'lFlfiru,1 Snptns R4 'l

rirlaflfifialaeJlnn'i1 7s tl firfia.o t 'Lu s{q

za.onriru{rJra (iaunr 20.3) ruarfirl:vrhrflut sf A v t &L:nn?1ilnutnmnfl{ :aflas 44.9 rTt'tuu

n1:'Iff ice pack irruriurmrrfi nnr:dor

UILIUU air lock fl1tJ11flann?1iltiuil?nfln

n'r:Anul LMWH tfra rir.lfi u-grir riru rda.,:orn

Fl ?'r rJ r fi u ar ru r : fl n n a 1 n 1 trj r pr"[u-:, a y L? n'tVttetooea.Jdu.l LFt LFtu111 tlltnnA1n1Tt',ttil?\',tsyt

tfrru threshold riarnrrur6uilrpr uavnaortrlov

n1:u'ldrUfU'liuil:sd1n?A{ la afferent-taxvouxooesensory fiber iltnu\:Ldu Lunn1iltuoTtl L?lnflilavyXeFhl Fl ? ? o { n n 1 il tu o n n n.,:

( 3) :t ru t{.,: n :y fr u rir iun?l eJff; n du't fl'Ludila.,: d:unnr.: lmorpnine{,receptor) (frtfiiunrT rurfiuffindula a1n1r

il a or 6.: n n n.,: Fr1 rJ ri 1 u a n a1 ;dn m er r fi u fl.: a orvoud'rr:r nr:ilr A'nLrur ruil?e61111fl a{ !#url:varnfi

o d .- -

o

dr nm er riurh otrirtfrtl nil:cm n'11 u r6uil'l Fr{(gate control theory) rflur.rntfrnnn?1eJ

u6uilrortffLufiaorq

d:il.lAv I v a d

n1:1fl ice pack ??3JnuLmnunfl1:flFt

Erluuu air lock lufirhul:nraanrdaorlr-r'lqlrvvLsJ d1 eJ1:611-l A{ nU narrfi nn1?s16a a 80 n

lfrfi rmri.: uoiarill:nan n?1rur6urJrnlfiJaavrfr .,:i 6 n'r : pi'.: n ri r r d r ru r : n rirhj'lfr'Lu n 1 r n u a

frdru'luma{rJrudu I riohJ{g

AAIRnfln:rillJrunrfl

%s v v an fuvr.l?a fl ?afl ou nfutalfi u']11y{ fl 't1l1n

qtq

mafirjrflrafnl:nri'rlo rorirhaarffirnrNfi 6t{ 1{sqsrvaf

naeJflaJul:3uuu:n1Td?R1n [:.,]T{u'tx1nq9d'v<*tyrdooau6l?::nu:8fl1:nu r lfi n?1eJ:2rJila tun1lyr1?au

uns ro.0F[1fln:1a1rf pranrnai Saaran

u1flrtlt?1u{cruFllf,': 1l?1sJ'tuuYt uas ta.ldO a A a

Fn d n:1A15EI{ Lrjvl5 n1qd5 r{'l?t15s1 t1 Aafl B t1

nfi fi n unurtfi 4m1.l nr:unm d nruuunyt El dldniadori"Y

Nfi 'ri?1 fl 1 a fl rf, a.,:'Lvr ri fi uuvri, rn rt au'luo au

n1Tn1?qu

1i.-

i

B rinur rm6o.:snrlad, n:rfinr{ qrdruo dlT:Fi'il:utrindtrrar:

9Atondl:o1{o{1. ri'rrinulallutravunfi ffini, ritinmuiln'nn:vn:r{d1fi1:6iJqz. flaryaafifi [ontine].

-Aayaqqt'-[?umdunu 24 N.il. 2552]; Avaitable from: URL: http://bps.ops.moph.go.th/index.php?mod=bps&doc=S

2. d:ru Uru'Lut'anqnri. rl.rLdan'[unr:inu1fl1?v?1a0or16oorar'Lqonriurfiuun#uJ" -

(Flauil 1) nnun 2537;10: 685-90.3. Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity,

pain threshold and pain tolerance. Br Journal Sports Med 2007; 41: 365-9.4. Hunter J. Subcutaneous injection technique. Nurs Stand 2008; 22(21): 41-4.5. Levy JH, Tanaka KA, Hursting MJ. Reducing thrombotic complications in the

perioperative setting: an update on heparin-induced thrombocytopenia. AnesthAnalg 2OO7; 105(3): 570-82.

6. Lisinski P, Jozwiak D, Samborski W. Cold-therapy and cryotherapy in managementpatients with shoulder pain. Chir Narzadow Ruchu Ortop Pol 2005; 70(6): 435-8.

7. Carter NJ, McCormack PL, Plosker GL. Enoxaparin: a review of its use in

ST-segment elevation myocardial infarction. Drug 2008; 68: 6g1 -71O.8. Rushing J. Administering an enoxaparin injection. Nursing 2008; 38(3): 19.

9. Best D, Grainger P. Treating acute coronary syndromes with enoxaparin. Nursing2OO4; 3a(5): 32cc1 -32cc2.

10. Daily EK. Clinical management of patients receiving thrombolytic therapy. Heart Lung

1991; 20 (pt 2): 552-65.11. Chan H. Effects of injection duration on site-pain intensity and bruising associated

with subcutaneous heparin. J Adv Nurs 2001; 35(6): 882-92.12. Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute

soft-tissue injury: a systematic review of randomized controlled trials. Am J SportMed 2004;32:251-61.

13. Kuzu N , Ucar H. The effect of cold on the occurrence of bruising, haematomaand pain at the injection site in subcutaneous low molecular weight heparin. lnt JNurs Stud 2OO1;38(1): 51-9.

: d or urlor EJ'Ifi rnn fi a *a i5 a n oi a n r r ru"r6 u ilr n ua c

n,lTtnn:aflL:n[urJ1]?EIYI[nTUn1:0nmrmn613Jrua Gnuruylurililu'tFt'tdn5ilfi'tufufrn).ffna{1n1Tltu1u1a. uIarfiflivrella-El. fl:.rLy.r}rsJ?11unr: rumrimEn#rleJfinn; 2s36.

15.Zaybak A, Khorshid L. A study on the effect of the duration of subcutaneous heparininjection on bruising and pain. J Clin Nurs 2OO7; 17: 378-BS.

16.McCaffery M, Beebe A. Pain: clinical manual for nursing practice. Baltimore: V.V.Mosby Company; 1993.

a da ^v

a €y aav17. mfiuili fiuoT:. nffiTatruafrm:1$i{ailnnr.rdfififiru spss. fltrtrilyly: uidn 6. fiurmai

xdtsqlt'l:Un; 2549.

18.Collet JP, Montalescot G, Fine E. Enoxaparin in unstable angina patients whowould have been excluded from randomized pivotal trials. J Am Coll Cardiol2003;41(1): 8-14.

iF!iE

E

Fi;ItEE

sEeE

I

Honoqnuli ice pack jrlfrurmnfinnuiauuruu pir lock tfioila.rfiunr:tf,antxt6oaoonldfianriluovannrul6rirhalu{rJral:nflaanr6oa#alofftiiunudaar low molecular weight heparin

-.r _ a Effects of lce Pack with Air Lock Technique Iniection to Prevent Subcutaneous Bleeding and pain in nlln I auuYl 1 :J.n.-ut.fl. 2

jvd,FrrTr.,rfi t {aunvr-rtrl

v?railas

'Iff tce Pack(N = 6'1)

lru'lfr tce Pack

(N = 69) P valueo

a1u?uvTAUAC a1u?u

I:aflav

ty'lFI

m€.:

{1ti

a1q

=. 60 tl61 -75{l

d,>75 1l

a1?Jra6u (tl) mean (SD)aa 9t

fl1:?UOflEl[1Fr

Non STEMI.

STEMI

Unstable angina

58

3

15

27

19

66.6

32

1B

7

4

(e5.1)

(4.e)

(24.6)

(44.3)

(31.1)

(12.1)

(52.4)

(2e.s)

(11.5)

(6.6)

(1.7)

(4.e)

(82,494)

(7.1)

(16.4)

(8.5)

77.0

58

1'l

20

35

14

69.4

10.8

32.4

273,536

25.9

14.4

1.4

31

0.051

(84.1)

(15.e)

0.182

(2e.0)

(50.7)

(20.3)

(11.8)

o.429

(55.1)

(33.3)

(2.e)

(8.7)

(2.5) 0.646

(7.2) o.B4e

(108,080) O.21g

(7.5) 0.e14

(5.4) o.B6e

(14-7) 0.21544.9 0.269

38

23

2

6Deep vein thrombosis

,{nm1.,lfro{rJfi ffi nr: mean(SD)

Hemoglobin (g/dl)

Hemato crit (%)

Platelet count (cell / mm3)d

PTT* (?u'111)d

PT. (?u1Tr)

INR*

rfl ul:n nyr ru oiula fi m 4.,:

10.9

32.7

252,197

26.1

17.3

1.1

47

* STEMI = ST - Segment elevation myocardial infarction, PTT = Partial thromboplastin time,

rtT Frctlrraml+in *ima, lltil-t l-.^-^+:^^^l ^^--^l:-^a -^+i^

10 fraur rutiorqnr;ati, n:rfin',C qriLold,va

d??:nu?st1:nur?{611:

f, , % rf eu J a o rm1:1{7r 2 1J1s?nn 1: [Ft:U A1ncn1 Elnil raaq [u [:.,]fl rj1u1a

r ua t4uu I AilTe? n n1T tFt:lJ H1 Avnl Et ei il rdA Ft

1fr lce Pack lr.rlfr tce Pack P valueoue1u?u :aflau

oyalu?u ToHas

rrrT rur{ufiu?o.,1u1 LMWH fla;,0.4 mg

0.6 mgo iil &y-

a1u?UnT{?ltFtTUEt't LMWH mean (SD)i a Atgr- J ;

u1nua1 unilraanm LnTUrilar:il n1:

inuT

Streptokinase

Clopidogrey

Acetylsalicylic acid (ASA)

Heparini a &y- , A

fllfls6lUAiltA0nn LflTUmAtUA\: **

Clopidogrey

Acetylsalicylic acid (ASA)

' Warfarin

20

41

6.2

1

1

61

0

4

61

3

I60

6.3

12

66

1

(32.8)

(67.2)

(3.2)

(1.6)

(1.6)

(100)

(6.a)

(1oo)

(4.e)

(13.0)

(87.0)

(2.6)

(4.4)

(81.2)

(1.5)

(17.4)

(e5.7i

(1.5)

0.007

0.928

0.469

0.622

< 0.001

1.000

0.068

0.247

0.341

0

3

56

1

** frdrsur.,::rutdiumrnnn'i1 1 tfipr

flara{nrili ice pack iarfrurmafinnr:6aguruu air lock r#oitosfiunr:rfienrrsr6oeoanlsiFrrdliluocoanrtlririJaalurftJrsl:nnooar6oafirltfitiYunr:6ogt low molecular weight heparin

Efferts o{ Ice Pack with Air Lock Technique Inieclion lo Prevent Subcutaneous Bleeding and Pain ind.J v eilYl I ouun I x.n.-rlJ.?I, 2554 Disease Patients That Usdd Low Molecular l4lei

Fr1:1{Yra aqa - A u d3 fl 1?sta a n a o n La r{??1u.,111fl u uas:snu n?1 3J Lauil? o

ty

flaila{'Ifr lce Pack lru1fr tce Pack

or,o1ulu ?ounuoya1u?u Taflne

P value

a oua - A &fl 't?eta 0 a aa n ta r,r?14u.,lYtvtu (a:.,1)

Petechiae

PurpuraJ

?u'tnYly,lu (LJ8,t.) mean (SD)

Echymosisj

?u1nmflu (r.nr.) mean (sD)

Hematoma

uurrrfiyru (sJsJ.) mean (sD)I a olva v

Tsuct?alml^lufl 't?cta a a a a n [m 9J?]1un

nT.,]$:n (til.)

12

24

36

48

60I

TeH&r?a1t0au (uil.) mean (sD)

nvtLuun?lilrtuil?n mean (sD)

51

49

5.7

21

27.4

I23.9

17

22

5

5

1

24.2

2.3

(83.6)

(80.3)

(2.8)

(34.4)

(1e.3)

(14.8)

(14.1)

(34.0)

(44.o)

(10.0)

(10_0)

(2.o)

(12.2)

(1.2)

44

48

6.4

23

24.3

12

21.3

13

17

11

6

1

27.3

2.7

(63.8) 0.0'17

(6e.6) 0.225

(3-o) 0.233

(33.3) 1.000

(11.3) 0.524

(17.4) 0.812

(1 1.1) 0.636

(27.1)

(35.4)

(22.e)

(12.5)

(2.1)

(12.8) 0.237

(1.1) 0.031