Comparison of the effects of two topical drugs, Piroxicam and Amla, on pain intensity caused by fistula cannulation in hemodialysis patients.

Dissertation

Master's degree in intensive care nursing

Abstract:

Introduction: End-stage renal failure patients perceive the pain caused by repeated fistula cannulations as the most severe stress resulting from the process. They consider treatment to be the biggest concern of their lives. As one of the basic goals of their actions, nurses are responsible for relieving this pain. Therefore, this study was conducted with the aim of determining the effect of two topical drugs, piroxicam and emla, on the severity of pain caused by fistula cannulation in hemodialysis patients. Materials and methods: This study was conducted using a clinical trial method on 75 patients referred to the dialysis department of Shohdai Eshair Hospital, Khorramabad in 2012. Patients were randomly divided into three groups A (piroxicam), group B (Emla) and group C (placebo). The data collection tool of the questionnaire includes three sections of demographic information, visual pain measurement scale (VAS) and a checklist of possible side effects of drugs. Pain intensity during fistula cannulation was measured in three groups, on two occasions before and after the intervention. Kruskal-Wallis and Mann-Whitney statistical tests and spss19 software were used to analyze the data. Findings: Based on the results, there was a statistically significant difference between the median pain intensity in the three groups before and after the intervention (p<0.001). The highest mean reduction in pain intensity was in Amla, Piroxicam and placebo groups, respectively. At the same time, 16% of the patients in the Amla group had short-term side effects, whitening of the fistula area.

Conclusion: The results of this study showed that Amla ointment and piroxicam gel were effective in reducing the pain caused by fistula cannulation in dialysis patients. Therefore, based on the results of this study, it can be suggested that Amla ointment and piroxicam gel are an easy method that can be used by the patient himself to reduce Pain during fistula cannulation of hemodialysis patients should be used.

Key words: piroxicam gel, spelling ointment, pain, cannulation, fistula, hemodialysis patients

Statement of the problem

Statement Problem:

Chronic kidney disease1 is a range of different pathophysiological processes, associated with abnormal kidney function and a progressive decrease in glomerular filtration rate2 (GFR) [1]. The discouraging term end-stage renal disease refers to a stage of failure in which the accumulation of toxic substances, fluids, and electrolytes that are naturally excreted by the kidney causes uremic syndrome3. This syndrome leads to the death of the patient, unless the toxic substances are removed by kidney replacement treatments, the use of dialysis4 or a kidney transplant5 [1].

Every year, millions of people suffer from this disease and huge financial costs are spent on it in the health system. In the United States, kidney disease is one of the main causes of morbidity and mortality. The prevalence of kidney failure is 3,500 new cases per year, and the prevalence of over 1,000 cases per million population is predicted in developed countries [2]. Currently, the prevalence of chronic kidney failure is increasing all over the world.

In 2000, the number of chronic kidney failure patients under treatment around the world was about 1,100,000 people, at the end of 2009, the number of these patients reached 2,654,000 people (which, with an increase of 6-7%, has grown significantly more than the world population) [3]. It is estimated that in 2020, the number of hemodialysis patients will reach 3,500,000 [4]. Uremic syndrome 4. Dialysis 5. kidney transplant

The overall incidence of this disease is 260 cases per one million population per year and it increases approximately 6% every year [1].In Iran, its prevalence and incidence increased from 49.234 per million people in 1380[5] to 357.863 per million people in 1386[6] and according to the available reports, the prevalence of this disease is increasing[7,8]. According to the reports of Iran Kidney Patients and Kidney Transplantation Research Center in 2016, about 29,000 patients with end-stage renal failure 1 were being treated, of which 14,000 people, 48.5%, were being treated with hemodialysis 2 [9].  

Given the prevalence and high incidence of this disease, its control and treatment is of great importance. Among the important methods of its control and treatment, we can mention hemodialysis, peritoneal dialysis 3 and kidney transplant. Hemodialysis is the most common treatment method in alternative methods in patients with kidney failure [7, 8], which is used in Iran and the world [6]. Widespread access to dialysis has prolonged the lives of hundreds of thousands of patients with end-stage renal disease (ESRD) [1]. The purpose of dialysis is to remove excess substances from the body and to stabilize the internal environment of the body, and it is also a method for immediate removal of toxins and poisons that cause permanent or fatal damage and injury.

In the world, the death rate of ESRD patients is the lowest in Europe and Japan, and in developing countries, due to limited access to dialysis, this rate is very high. In the United States, the death rate of dialysis patients is about 18-20% per year and the 5-year survival rate is about 30-35% [1].

Access to the patient's blood flow is needed for hemodialysis of kidney failure patients. Fistula5, graft6 or catheter7 through which blood enters the dialysis system are called vascular access8 [1]. Harwich9, Briska10, and Apple11 in 1966 reported the surgical technique of fistula between artery and vein, which today is known as the best means to achieve proper vascular access for patients who need chronic hemodialysis[10]. Fistula has a very high long-term success rate among all dialysis access options [1] and arteriovenous fistula (AVF)12 can be considered as the gold standard for vascular access in dialysis patients [11]. 1. End-stage renal disease (ESRD) 2. Hemodialysis 3. Peritoneal Dialysis

4.Toxins 5.Fistula 6.Graft 7.Catheters 8.Vascular access

9.Hurwich 10.Brescia 11.Appel 12.Arteriovenous fistula (AVF)

Fistula is created by connecting an artery to a vein. comes and causes the vein to have arterial blood, this operation makes it possible to use large needles (especially G 15) to access the blood flow[1].

Dialysis hours for most ESRD patients, between 9-12 hours are needed every week, which is divided into three almost equal periods[1] and in each session, blood flow through two needles, one to take blood and the other to return blood to the The body is established [12 and 13]. Therefore, end-stage kidney patients frequently face stress and pain caused by 300 fistula cannulations per year [11, 14, 15].

Pain 2 is a multidimensional phenomenon that is difficult to define, and it is a sensory and individual experience, two people's experience of pain is not completely alike[16]. Pain is a mental experience, an unpleasant feeling that is related to possible or certain tissue damage [17] and is often associated with fear, worry and anxiety [18].

The International Association of Pain (IASP)3 in 1979 defines pain as follows: pain is an unpleasant feeling and an emotional experience that is associated with potential or actual tissue damage[19]. Pain is not only caused by the underlying disease, but may also be derived from many invasive diagnostic and therapeutic procedures [20]. Diagnostic and therapeutic methods are known as one of the most stressful medical events [21]. Intravenous catheter placement is one of the most common painful invasive nursing procedures [22, 23].