الفهرس 
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Abstract
The Intensive Care Unit (ICU) provides care for the most vulnerable patients. Critically ill patients require quick decision making that denote the difference between life and death. One laboratory test that enhances such decision making is ABGs analysis. It is usually performed on multiple arteries, including the radial, brachial, and femoral arteries. The most common site of arterial puncture is the radial artery. Arterial puncture is considered a safe and simple procedure, but it is not without risk. During arterial puncture the most common signs that may occur at puncture site including pain/ severe discomfort, vasospasm, hematoma formation and hemorrhage.
Arterial puncture is frequently performed by critical care nurses (CCNs) without pain management which is considered routine method in ICUs. The pain associated with arterial puncture can cause anxiety and discomfort. Nurses have the ability to reduce patients’ pain after arterial puncture using non-pharmacological interventions. Ice application on radial artery is a simple and inexpensive therapy which has been accepted for decades as an effective non pharmacologic intervention for pain management.
Researchers examined various pharmacologic methods for reducing pain associated with arterial punctures. Use of local anesthesia to decrease pain associated with arterial puncture is one of the pharmacological methods. Various studies have confirmed the effectiveness of lidocaine spray for pain relief and other studies have confirmed the effectiveness of ice on reducing labor pain.
Aim of the study:
This study was conducted to compare routine method versus application of ice or lidocaine spray on occurrence of pain and local signs associated with arterial puncture.
Materials and method:
To fulfill the aim of this study a quasi – experimental research design was used. This study was carried out in two general ICUs of Damanhur Medical Institute and Kafr El Dawar hospitals.
A convenience sample of 62 newly admitted critically ill patients in need for arterial puncture from radial artery at least once daily for three consecutive days were included in the study. Patients who had negative Allen Test, impaired sensation and other infections at puncture site, and arteriovenous fistula or fractures in selected arm were excluded from this study.
To accomplish the aim of the current study; one tool was used for data collection ’’Pain and local signs associated with arterial puncture assessment record’’ it includes three parts: Part I consisted of patient’s demographic and health relevant data including age, sex, education, current diagnosis, past medical history, and laboratory investigations. Part II consisted of pain assessment scales which include two scales for conscious patients (NRS, WBRS) and one scale for unconscious patients (NVPS). Part III covered occurrence of local signs after arterial puncture.
The main results of the current study:
More than half of the studied patients was male and aged between 40-<60 years old. The most common diagnosis was neurological disorders. Most patients received anticoagulant medications.
The current study findings revealed that all patients had pain when using routine method compared to 29.4% , 35.3% using ice and lidocaine spray respectively. from this study, it was observed that ice is effective in reducing pain in conscious patients after 10 and 20 minutes than lidocaine spray and routine method.
There are statistically significant differences between using routine method versus application of ice and lidocaine spray in relation to pain occurrence and severity in conscious patient when using Numerical Rate Scale at different times (immediately, 10 minutes, 20 minutes) after arterial puncture (p< 0.020, 0.000 and 0.000).
Concerning pain quality, it was noted that 73.5% of the studied patients had sharp pain when using routine method of arterial puncture. On the other hand, only 11.8% of patients had sharp pain when using ice and lidocaine spray. All patients (100%) reported need for analgesic when using routine method of arterial puncture. On the other hand, none of patients reported need for analgesic when using ice and lidocaine spray.
Concerning local signs after arterial puncture, it was observed that the majority of patients had bleeding, hematoma, and ecchymosis when using routine method and lidocaine spray, on the other hand, only 6.5% of the studied patients had bleeding, hematoma and ecchymosis when using ice.
Conclusion
Ice pack as a simple, non-invasive and inexpensive technique could be effective in reducing pain and local signs associated with arterial puncture, while lidocaine spray was effective only in reducing pain associated with arterial puncture
Recommendations:
Based on the conclusion of the present study, the following recommendations are suggested:
Encourage the critical care nurses’ to use ice pack before arterial puncture.
o Provide ice pack facilities in Intensive Care Units.
o Add steps to arterial puncture check list for the student nurses about items of ice application before arterial puncture procedure.
o Motivate the critical care nurses who apply ice pack on arterial puncture site before procedure
o Replicate this study on a larger sample for generalization.