title: [The effectiveness of a cold application for pain associated with chest tube removal: a systematic review].
abstract: BACKGROUND
  Several previous studies have investigated the effectiveness of cold applications for pain associated with chest tube removal (CTR). However, the results of these studies are mutually contradictory.
  
  
  OBJECTIVE
  The aim of this study was to determine the evidence related to the effectiveness of using a cold application to reduce the pain associated with CTR.
  
  
  METHODS
  This review focused on studies published before June 2014 that were indexed in the following databases: Cochrane Library, PubMed, MEDLINE, CINAHL, ProQuest, Airiti Library, and National Digital Library of Theses and Dissertations in Taiwan. Keywords that were searched included: chest tube removal, cold application, and pain within a search design based on the PICO (patient, intervention, comparion, outcome) structure. Only randomized controlled trials (RCTs) that evaluated the efficacy of cold application in patients before CTR were included in analysis. Study quality was assessed using the Modified Jadad scale.
  
  
  RESULTS
  Five RCTs that enrolled a total of 426 patients were included in the analysis. The mean age of participants ranged from 48.7 (SD = 16.5) to 60.2 (SD = 6.2) years. Ice packs were most widely used and applied to an area approximately 5-15 cm in diameter, with the chest tube entry point at the center. The findings of the effectiveness of the cold application were inconsistent among the studies. The researchers terminated the cold application when patients' skin temperature reached 13°C or after 20 min, which showed that the cold application immediately reduced the pain associated with CTR. It was also observed that the cold application prolonged the duration of time between the CTR and the administration of analgesics. Additionally, two studies in which analgesics were administered to participants 60 min before CTR showed that cold application in combination with analgesics administration reduced patient pain due to the enhancement affects of CTR, which obtained results that were better than analgesics administration alone.
  
  
  CONCLUSIONS
  The results of this study may be used as a reference for reducing pain associated with CTR in clinical practice. However, further studies with larger sample sizes are required to support these results.
authors: Department of Nursing, Surgical Ward, Chia-Yi Christian Hospital, Taiwan, ROC.
authors: Yi-Rong
authors: YR
authors: Chen
authors: Department of Nursing, Chia-Yi Christian Hospital, Taiwan, ROC. 10023@cych.org.tw.
authors: Ling-Yu
authors: LY
authors: Hsieh
mesh_terms: D000328:Adult; D000368:Aged; D015505:Chest Tubes; D003080:Cold Temperature; D020878:Device Removal / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control*
keywords: chest tube removal; cold application; pain; systematic review