Turkiye Klinikleri Journal of Nursing Sciences

.: REVIEW
Orogastrik Tüp Takma İşlemindeki Ağrıyı Azaltmada Önerilen Nonfarmakolojik Yöntemlere Karşın Sınırlı Sayıda Çalışma: Literatür Değerlendirmesi
A Limited Number of Studies Against Recommended Non-Pharmacological Methods for Pain Relief During Orogastric Tube Insertion: A Review of Literatüre
Vildan APAYDIN CIRIKa, Emine EFEb
aGümüşhane Üniversitesi Sağlık Bilimleri Fakültesi, Çocuk Sağlığı ve Hastalıkları Hemşireliği ABD, Gümüşhane, TÜRKİYE
bAkdeniz Üniversitesi Hemşirelik Fakültesi, Çocuk Sağlığı ve Hastalıkları Hemşireliği ABD, Antalya, TÜRKİYE
Turkiye Klinikleri J Nurs Sci. 2020;12(2):263-71
doi: 10.5336/nurses.2019-65005
Article Language: TR
Full Text
ÖZET
Yenidoğan yoğun bakım ünitesinde yenidoğanların beslenmesini desteklemek için orogastrik tüp (OGT) ile beslenme sıklıkla kullanılan bir yöntemdir. Yapılan çalışmalar ve uluslararası rehberler, OGT takma işleminin yenidoğanlarda akut ağrıya neden olduğunu göstermektedir. OGT takma işlemi nedeni ile oluşan bu ağrıyı azaltmak için de nonfarmakolojik yöntemler önerilmektedir. Bunlar arasında; sarmalama, oral sukroz verme ve pozisyon verme yöntemleri yer almaktadır. Bu nonfarmakolojik yöntemlerin etkili olduğu belirtilmesine karşın, literatürde OGT takma işlemi nedeni ile oluşan ağrıyı azaltmak için kullanılan nonfarmakolojik yöntemlere yönelik sınırlı sayıda çalışmaya rastlanılmıştır. Türkiye'de ise bu konu ile ilgili yapılan herhangi bir çalışmaya rastlanılmamıştır. İlaveten, OGT takma ve değiştirme işleminin sorumluluğu hemşirelere ait olduğu için hemşirelerin etkili nonfarmakolojik yöntemleri bilmeleri ve uygulamaları da son derece önem taşımaktadır. Bu nedenler göz önüne alındığında; bu çalışmanın literatürdeki eksikliğin ortaya konulmasına yardımcı olacağı ve yapılacak olan çalışmalara temel bir veri sağlayacağı düşünülmektedir. Bu çalışmada, literatür gözden geçirilerek yenidoğanlarda ağrılı bir işlem olan OGT takma girişimi nedeni ile oluşan ağrının değerlendirilmesi, ağrıyı azaltmada kullanılması önerilen nonfarmakolojik yöntemlerin incelenmesi ve ağrı yönetiminde yenidoğan hemşirelerinin görev/yetki/sorumluluklarının açıklanması amaçlanmıştır.

Anahtar Kelimeler: Yenidoğan; ağrı; yenidoğan hemşireliği
ABSTRACT
Orogastric tube (OGT) feeding is a frequently used method to support the feeding of newborns in the neonatal intensive care unit. Studies and international guidelines indicate that OGT insertion causes acute pain in newborns. Non-pharmacological methods are recommended to reduce this pain caused by OGT insertion. These include; swaddling, oral sucrose and positioning. Although these non-pharmacological methods are reported to be effective, a limited number of studies have been found in the literature on non-pharmacological methods used to reduce pain caused by OGT insertion. In Turkey it did not reveal any studies on this subject. Additionally, as the responsibility of the OGT installation and replacement process belongs to the nurses, it is also important that nurses know and practice effective non-pharmacological methods. Considering these reasons; it is thought that this study will help to reveal the deficiency in the literature and provide a basic data to the studies. In this study, we aimed to evaluate the pain caused by OGT insertion procedure which is a painful procedure in preterms, to examine the recommended non-pharmacological methods used to reduce pain and to explain the duty/authority/responsibilities of newborn nurses in pain management.

Keywords: Newborn; pain; neonatal nursing
REFERENCES:
  1. Resmi Gazete (19.04.2011, Sayı: 27910) sayılı Hemşirelik Yönetmeliğinde Değişiklik Yapılmasına Dair Yönetmelik; 2011. p.1.
  2. CMNRP. Ottawa Neonatal Pain Interest Group. Newborn Pain Management: A Practical Approach Self-Learning Module; 2015. p.22.
  3. Nimbalkar S, Sinojia A, Dongara A. Reduction of neonatal pain following administration of 25% lingual dextrose: a randomized control trial. J Trop Pediatr. 2013;59(3):223-5. [Crossref]  [PubMed] 
  4. Pandey M, Datta V, Rehan HS. Role of sucrose in reducing painful response to orogastric tube insertion in preterm neonates. Indian J Pediatr. 2013;80(6):476-82. [Crossref]  [PubMed] 
  5. Chen S, Zhang Q, Xie RH, Wen SW, Harrison D. What is the best pain management during gastric tube ınsertion for infants aged 0-12 months: a systematic review. J Pediatr Nurs. 2016;34:78-83. [Crossref]  [PubMed] 
  6. Bellieni CV, Iantornao L, Perrone S, Rodriguez A, Longini M, Capitani S, et al. Even routine painful procedures can be harmful for the newborn. Pain. 2009;147(1-3):128-31. [Crossref]  [PubMed] 
  7. Saugstad OD. Oxidative stress in the newborn--a 30-year perspective. Biol Neonate. 2005;88(3):228-36. [Crossref]  [PubMed] 
  8. Aliefendioğlu D, Güzoğlu N. [Pain in newborn]. Çocuk Sağlığı ve Hastalıkları Dergisi. 2015;58:35-40.
  9. Johnston C, Barrington KJ, Taddio A, Carbajal R, Filion F. Pain in Canadian NICUs: have we improved over the past 12 years? Clin J Pain. 2011;27(3):225-32. [Crossref]  [PubMed] 
  10. New South Wales Government Health Guideline. Infants and Children Insertion and Confirmation of Placement of Nasogastric and Orogastric Tubes; 2016. p.21. Document Number: GL2016_006. Issue date: February-2016.
  11. Savaşer S. [Basic neonatology and nursing principles]. Dağoğlu T, Görak G, editörler. Yenidoğanın Beslenmesi. 1. Baskı. İstanbul: Nobel Tıp Kitabevleri; 2008. p.211-31.
  12. McGrath JM, Braescu AV. State of the science: feeding readiness in the preterm infant. J Perinat Neonatal Nurs. 2004;18(4):353-68. [Crossref]  [PubMed] 
  13. Briere CE, McGrath J, Cong X, Cusson R. State of the science: a contemporary review of the feeding readiness in the preterm infants. J Perinat Neonatal Nurs. 2014;28(1):51-8. [Crossref]  [PubMed] 
  14. Babl FE, Crellin D, Cheng J, Sullivan TP, O'Sullivan R, Hutchinson A. The use of the faces, legs, activity, cry and consolability scale to assess procedural pain and distress in young children. Pediatr Emerg Care. 2012;28(12):1281-96. [Crossref]  [PubMed] 
  15. Babl FE, Mandrawa C, O'Sullivan R, Crellin D. Procedural pain and distress in young children as perceived by medical and nursing staff. Paediatr Anaesth. 2008;18(5):412-9. [Crossref]  [PubMed] 
  16. Morrison RS, Ahronheim JC, Morrison GR, Darling E, Baskin SA, Morris J, et al. Pain and discomfort associated with common hospital procedures and experiences. J Pain Symptom Manage. 1998;15(2):91-101. [Crossref] 
  17. Derebent E, Yiğit R. [Pain in newborn: assessment and management]. CU Hemşirelik Yüksek Okulu Derg. 2006;10:41-8.
  18. Dinçer Ş, Yurtçu M, Günel E. [Pain in newborns and nonpharmacologic treatment procedures]. Selçuk Üniv Tıp Derg. 2011;27(1): 46-51.
  19. International Association for the Study of Pain (IASP). Acute pain management in newborn infants; 2011. Erişim Adresi: http://www.iasp-pain.org/PublicationsNews/NewsletterIssue.aspx?ItemNumber=2075 Erişim tarihi: 18 November 2018).
  20. Melzack R, Wall PD. Pain mechanism: a new theory. Science. 1965;150(3699):971-9. [Crossref]  [PubMed] 
  21. Czarnecki LM, Turner HN, Collins PM, Doelman D, Wrona S, Reynolds J. Procedural pain management: a position statement with clinical practice recommendations. Pain Manag Nurs. 2011;2(12):95-101. [Crossref]  [PubMed] 
  22. Ballweg D. Neonatal and pediatric pain management: standards and application. Paediatr Child Health. 2007;17(1):61-6. [Crossref] 
  23. uo YW, Yen M, Fetzer S, Lee JD. Reducing the pain of nasogastric tube intubation with nebulized and atomized lidocaine: a systematic review and metaanalysis. J Pain Symptom Manage. 2010;40(4):613-20. [Crossref]  [PubMed] 
  24. Büyükgönenç L, Törüner EK. [Pediatric nursing]. Conk Z, Başbakkal Z, Bal Yılmaz H, Bolışık B, editörler. Çocukluk Yaşlarında Ağrı ve Hemşirelik Yönetimi. 2. Baskı. Ankara: Akademisyen Tıp Kitabevi; 2018. p.881-99.
  25. Power DM, Bhadra A, Bhatti A, Forshaw MJ. Xylocaine spray reduces patient discomfort during nasogastric tube insertion. Internet J Surg. 2006;8:1e3. [Crossref] 
  26. Taddio A. Opioid analgesia for infants in the neonatal intensive care unit. Clin Perinatol. 2002;29(3):493-509. [Crossref] 
  27. Cong X, Cusson RM, Walsh S, Hussain N, Ludington-Hoe SM, Zhang D. Effects of skin-to-skin contact on autonomic pain responses in preterm infants. J Pain. 2012;13(7):636-45. [Crossref]  [PubMed] 
  28. Cignacco E, Hamers JP, Stoffel L, Lingen RA, Gessler P, McDougall J, et al. The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. Eur J Pain. 2007;11(2):139-52. [Crossref]  [PubMed] 
  29. illai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, et al. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev. 2015;2(10):CD006275.
  30. Mangat AK, Oei JL, Chen K, Quah-Smith I, Schmölzer GM. A review of non-pharmacological treatments for pain management in newborn infants. Children (Basel). 2018;5(10):130. [Crossref]  [PubMed]  [PMC] 
  31. Karp H. The Happiest Baby on the Block. 2nd ed. New York, NY: Bantam Books; 2015. p.382.
  32. Campos RG. Soothing pain-elicited distress in infants with swaddling and pacifiers. Child Dev. 1989;60(4):781-92. [Crossref]  [PubMed] 
  33. tevens B, Gibbins S, Franck LS. Treatment of pain in the neonatal intensive care unit. Pediatr Clin North Am. 2000;47(3):633-50. [Crossref] 
  34. Leng HY, Zheng XL, Zhang XH, He HY, Tu GF, Fu Q, et al. Combined non- pharmacological interventions for newborn pain relief in two degrees of pain procedures: a randomized clinical trial. Eur J Pain. 2016;20(6):989-97. [Crossref]  [PubMed] 
  35. Huang CM, Tung WS, Kuo LL, Chang YJ. Comparisons of pain responses of premature infants to the heelstick between containment and swaddling. J Nurs Res. 2004;12(1):31-40. [Crossref]  [PubMed] 
  36. Hill S, Engle S, Jorgensen J, Kralik A, Whitman K. Effects of facilitated tucking during routine care of infants born preterm. Pediatr Phys Ther. 2005;17(2):158-63. [Crossref]  [PubMed] 
  37. Hunter J. Therapeutic positioning: neuromotor, physiologic and sleep implications. In: Kenner C, McGrath JM, eds. Developmental Care of Newborns and Infants: a Guide for Health Professionals. National Association of Neonatal Nurses. NANN; 2010. p.16.
  38. Axelin A, Salantera S, Lehtonen L. 'Facilitated tucking by parents' in pain managment of preterm infants: a randomized crossover trial. Early Hum Dev. 2006;82(4):241-7. [Crossref]  [PubMed] 
  39. Liaw JJ, Yang L, Katherine Wang KW, Chen CM, Chang YC, Yin T. Non-nutritive sucking and facilitated tucking relieve preterm infant pain during heel-stick procedures: a prospective, randomized controlled crossover trial. Int J Nurs Stud. 2012;49(3):300-9. [Crossref]  [PubMed] 
  40. Cignacco E, Sellam G, Stoffel L, Gerull R, Nelle M, Anand KJ, et al. Oral sucrose and "facilitated tucking" for repeated pain relief in preterms: a randomized controlled trial. Pediatrics. 2012;129(2):299-308. [Crossref]  [PubMed] 
  41. Kucukoglu S, Kurt S, Aytekin A. The effect of the facilitated tucking position in reducing vaccination-induced pain in newborns. Ital J Pediatr. 2015;41:61. [Crossref]  [PubMed]  [PMC] 
  42. Gibbins S, Stevens B. Mechanisms of sucrose and nonnutritive sucking in procedural pain management in infants. Pain Res Manag. 2001;6(1):21-8. [Crossref]  [PubMed] 
  43. Lago P, Garetti E, Merazzi D, Pieragostini L, Ancora G, Pirelli A, et al. Guidelines for procedural pain in the newborn. Acta Pediatr. 2009;98(6):932-9. [Crossref]  [PubMed]  [PMC] 
  44. Hacımustafaoğlu M. [Expanded immunization schedule routine vaccination schedule in Turkey]. Journal of Pediatric Infection. 2011;5(1):244-51.
  45. Gray L, Miller LW, Philipp BL, Blass EM. Breastfeeding is analgesic in healthy newborns. Pediatrics. 2002;109(4):590-3. [Crossref]  [PubMed] 
  46. Ou-Yang MC, Chen IL, Chen CC, Chung MY, Chen FS, Huang HC. Expressed breast milk for procedural pain in preterm neonates: a randomized, double blind, placebo controlled trial. Acta Paediatr. 2013;102(1):15-21. [Crossref]  [PubMed] 
  47. Rodrigues L, Nesargi SV, Fernandes M, Shashidhar A, Rao SPN, Bhat S. Analgesic efficacy of oral dextrose and breast milk during nasopharyngeal suctioning of preterm infants on CPAP: a blinded randomized controlled trial. J Trop Pediatr. 2017;63(6):483-8. [Crossref]  [PubMed] 
  48. ollados-Gómez L, Ferrera-Camacho P, Fernandez-Serran E, Camacho-Vicente V, Flores-Herrero C, García-Pozo A, et al. Randomised crossover trial showed that using breast milk or sucrose provided the same analgesic effect in preterm infants of at least 28 weeks. Acta Paediatr. 2018;107(3):436-41. [Crossref]  [PubMed] 
  49. Shah V, Ohlsson A. Venepuncture versus heel lance for blood sampling in term neonates. Cochrane Database Syst Rev. 2011;10(4): CD001452. [Crossref]  [PMC] 
  50. Cırık V, Efe E. Pediatric nurses' usage and experience toward complementary health approaches. J Altern Complement Med. 2018;24(11):1120-7. [Crossref]  [PubMed] 

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