A study to assess the effectiveness of cold compression on pain and ecchymosis on patients getting subcutaneous low molecular weight heparin in a selected tertiary care hospital

Background: Due to the advancement in preventive treatment modalities, the number of patients receiving LMWH is on rise. Low-molecular-weight heparin (LMWH) a class of anticoagulant, is used in the prevention and treatment of venous thromboembolism (deep vein thrombosis and pulmonary embolism) and various cardiovascular conditions and for prophylaxis and treatment of DVT in surgeries in pre and post op phase .One of the most commonly encountered adverse physiological responses to this intervention is pain and the formation of ecchymosis at the injection site. This creates a challenge for the nurses administering the LMWH to minimize ecchymosis and or patient discomfort during the treatment regimen. Aim: To assess the effectiveness of cold compress on pain and ecchymosis in patients getting subcutaneous LMWH. Methodology: In present study, the researcher selected a single group pre and post intervention (quasi experimental design, n=35). Keeping in view the objectives of the study, the investigator assessed the level of pain and ecchymo sis of patients getting subcutaneous heparin prior to cold compression; followed by assessing the level of pain and ecchymosis on administration of subcutaneous heparin after cold compression. In this study cold compression refers to use of readymade ice packs which were used on patients left arm for a period of 3 min before administering subcutaneous LMWH. Results : Out of 35 samples, without cold compression, majority 62.85%(22) of sample recorded their pain scale in moderate range 4-6 of pain scale , mild range 34.28%(12), severe range 2.8% (1).With intervention (cold compress for 3 mins at the site prior to administration) majority 65.7%(23) sample experienced mild range, moderate range 31.42%(11), severe range 2.85%(1). It implies that there was significant reduction in pain level of the subjects after administration of cold compress which makes it evident that application of cold compress is effective in reducing the pain. Out of the same 35 samples , subcutaneous LMWH was administered without cold compression and ecchymosis scale of grade 0 were 68.57%(24), grade 1 were 25.71%(9), grade 2 were 5.71%(2). With cold compression ecchymosis scale recorded of grade 0 were 91.42% (32) , grade 1 were 8.57%(3), grade2 and grade 3 shows 0%. It implies that there was significant reduction in ecchymosis level after cold compress which makes it evident that cold compression was effective in reducing the ecchymosis. Conclusion: Majority of patient had a decreased perception of pain and showed decreased evidence of ecchymosis [65.7%(23) & 68.57%(24) respectively], by the technique of cold compress application before administration of the injection. Therefore it can be concluded on the basis of this study that ice cold application was effective in reducing pain and ecchymosis and enhancing the comfort of patient.