“A PRE- EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF COLD

COMPRESSION ON BREAST ENGORGEMENT PAIN AMONG POSTNATAL

MOTHERS ADMITTED IN ERA MEDICAL HOSPITAL, (LUCKNOW).”

MSC NURSING DISSERTATION SYNOPSIS

ERA COLLEGE OF NURISNG

Era University Lucknow

- By

NAZIA GULZAR

MSc. Nursing (Batch 2017-19)

Under the guidance of:

Department of OBSTRIC AND GYNAECOLOGICAL nursing

Date: 26/11/2018
 ERA’S COLLEGE OF NURSING , LUCKNOW UTTAR PRADESH

NAME OF THE CANDIDATE AND MS.NIKITA

ADDRESS ERA’S COLLEGE OFNURSING

NAME AND ADDRESS OF THE GUIDE LT.COL.MRS.REENA BHOWAL

(RETD.)
(ASSOCIATE PROFESSOR)
ERA COLLEGE OF NURSING

NAME OF THE INSTITUTE ERA’S COLLEGE OF NURSING

COURSE MSc.NURSING
(2017-2019)

NAME OF DEPARTMENT MEDICAL SURGICAL DEPARTMENT

17 Aug.2017
DATE OF ADMISSION TO THE
COURSE

TITLE OF THE TOPIC A true experimental study to assess the

effectiveness cold compress in reducing the
intensity of pain due to intravenous
infiltration in cannulated patients at Era
Hospital Lucknow.
 CHAPTER- 1
INTRODUCTION
“An ounce of prevention is worth a pound of cure”
-Gregory Y
The history of intravenous therapy began with the discovery by Sir. Williams Harvey.
The first practical application was by Dr. Thomas Latta, who used infusion of saline to treat
the intractable diarrhea. Approximately 90% of patients in acute care setting receive some
form of intravenous infusion therapy.
The intravenous infusion is an important aspect of therapy under both medical and
surgical conditions. Physiologic homeostasis with in the body requires the presence of an
adequate supply of fluids. The fluids circulating in the body are composed of water,
electrolytes, minerals and blood cells. The imbalance in homeostasis may result from many
factors like injury, surgery and different kinds of medical illnesses. These imbalances can be
corrected by intravenous therapy. Intravenous therapy has become a lifesaving as well as life
sustaining therapy and the intravenous therapy is increasingly being performed by nursing
staff in hospitals. So, starting IV infusion and maintaining the patency of IV site needs
challenging skills among nursing personnel.
Administering drugs by the intravenous route has advantages. Often the nurse uses the
intravenous route in emergencies when a fast action of drug is required to save the life of the
casuality. Intravenous route is commonly used in critical care units as well as in general
wards .The intravenous route is best when patency of blood vessels is maintained Some
medications are highly alkaline and irritating to muscles and subcutaneous tissues. These
drugs cause less discomfort with maximum benefit when given intravenously.
Inspite of having lots of benefits infilteration is one of the most common problem of
intra venous therapy which can be prevented. Infiltration refers to escape of fluid in to the
subcutaneous tissues due to the dislodgement or malfunctioning of the cannula characterized
by swelling, pain or itching, burning, skin that is cool to the touch or discoloration.
proportionately as the infiltration worsens.
 The interior wall of a vein (the tunica intima) consists primarily of a single layer of
tightly packed endothelial cells. Injury to (or) irritation of this layer causes the release of
histamines, bradykinin and serotonin, these in turn initiates the pain response, dilatation of
the vein and increasing blood flow to the area. Capillary permeability also increases, allowing
fluids and proteins to leak into the interstitial space and causing oedema and tenderness.
Factors associated with the development of infiltration are integrity and state of veins,
insertion technique, cannula location, insertion into the bony extremity (or) movable joints,
size of cannula, use of steel needles, infusion of certain drugs, duration of therapy, increased
length of time over 24 hrs, interrupted blood flow, hyperosmolar parenteral fluids, PH, acidic
infusates, and duration of soft tissue exposure to vesicants.
When infiltration occurs infusion must be discontinued and if necessary re-inserted
into another extremity. To reduce discomfort caused by infiltration, the nurse should elevate
the extremity, which promotes venous drainage and helps to decrease Oedema, and wrap the
extremity in a warm towel for 20 minutes which increases circulation and reduces pain and
oedema.
Local responses to heat and cold occur through stimulation of temperature sensitive
receptors in the skin. Impulses travel from the periphery to the hypothalamus and the cerebral
cortex. The hypothalamus then initiates heat producing (or) heat reducing location of the
body. The conscious sensation of temperature is aroused in the cerebral cortex. cold
application is effective by decreasing swelling through, and hot application decreases
stiffness by increasing large diameter nerve fiber input to block small diameter pain fiber.
Managing an intravenous therapy regimen has become a common nursing
responsibility and it is the part of extended role of nurses. While, due to advances in
technology intravenous therapy is now relatively safe, but there is still possible chances for
serious complication to arise. Unfortunately, these complication are sometime regarded as
routine occurrence, but to overlook or underestimate the potential risk of intravenous therapy
result in loss of site, and cause patient discomfort (or) further injury.
 COLD APPLICATION

Vasoconstriction

Decreased blood flow

Increased blood viscosity

Decreased delivery of oxygen nutrients

Decreased cell metabolism

Decreased sensitivity of fibers and receptors

Decrease local pain

NEED OF THE STUDY
"The aim of the wise is not to secure pleasure but to avoid pain"
-Aristotle
Intravenous infusion has become an indispensable component in medical therapy. It is
used to correct electrolyte imbalances, to deliver medications, for blood transfusion or as
fluid replacement to correct dehydration. In spite of its therapeutic effects the most frequently
encountered problems are infiltration and extravasation. Unfortunately, they are so common,
that they are sometimes overlooked or not addressed as soon as they should be, or else they
can produce debilitating effects.
Therefore, nurses are in a pivotal position to manage infiltration through effective
nurse-initiated intervention that are economical in both nursing times and resources. In the
past, drugs have been the conventional methods to alleviate pain and swelling, but in many
instances, medications themselves do not provide optimal results. The modality of hot and
cold compression have a very appropriate role in the treatment of almost all injuries involving
soft tissues involves pain, possible bleeding and a leakage of fluid from damaged tissues into
the area.
A study conducted by infusion nursing society on incidence of intravenous catheter
complications in the hand and forearm reported that 67 patient had developed intravenous
catheter complication in a hospital over a three year period in which 56 minor complications
and 11 major complications. In 68% of minor complications, the patients were aged 50 years
or older and 68% were women in which minor complications comprised 26 intravenous
infiltrations and 23 cases of thrombophlebitis. The most common complication of peripheral
venous cannulation is infiltration which results in an inflammatory reaction, and is
manifested as pain, swelling, and erythema that may prolongs the duration of hospital stay.
A comparative study was conducted in Pune on effectiveness of hot fomentation
versus cold compress for reducing intravenous infiltration. The sample size was sixty patients
(30 for hot fomentation and 30 for cold compress) with mild to moderate degree of
infiltration stayed in hospital for 8-14 days and data was analysed by using descriptive and
inferential statistics. Findings prove that the pre-treatment mean score of degree of infiltration
was 7.1667 reduced to 0.7071 on the third day of treatment with hot fomentation. In cold
compress pre-treatment mean score 6.9333 reduced to 0.70571. The study concluded that
both hot fomentation and cold compress are effective in treatment of intravenous therapy
related infiltration
 In contrast, a study was conducted on effectiveness of warm versus cold applications
of intravenous infiltrations at Health Science Centre, New York. Differences in pain
intensity, surface area measurements of induration and erythema, and interstitial fluid volume
when warm versus cold applications were randomly made to an intentional intravenous
infiltrate of 5 ml of a designated solution were examined. Three solutions were used: 0.5
saline, normal saline, and 3% saline. Study was done with 18 samples .There was induration
and erythema was no difference in remaining infiltrate when 0.5 saline or normal saline were
used, but a significant (p<0.001) difference was found with 3% saline. Pain intensity did not
differ by treatment but a significant (p<0.005) difference was found by solution, with 3%
saline producing the greatest difference. Erythema was absent with all solutions. Surface
induration was affected by solution and decreased overtime (p=0.001) .There was no effect of
warmth or cold on surface area induration.
Some studies shows that hot and cold application is very effective in reducing
intravenous infiltration at the same time others shows there is no effect. Since it is
contradictory to nursing practice investigator felt that there is a need to check the
effectiveness of hot fomentation versus cold compress in reducing intravenous infiltration.

PROBLEM STATEMENT
A true experimental study to assess the effectiveness cold compress in reducing the
intensity of pain due to intravenous infiltration in cannulated patients at Era Hospital
Lucknow.

OBJECTIVES
 To assess the effectiveness of cold compress in reducing the intensity of pain due to
intravenous infiltration in cannulated patients at Era Hospital Lucknow.

OPERATIONAL DEFINITION
Effectiveness:
The degree to which something is successful in producing a desired result (oxford dictionary)

In this study, effectiveness refers to the extent to which the hot fomentation and cold
compress in reducing intravenous infiltration and pain as measured by infiltration
measurement scale and numerical pain scale respectively.
Cold compress:
Cold compress is a local moist cold application made out of folded layers of gauze, lint piece
or old soft linen, wring out of cold or ice water or in some evaporating lotion applied to the
required area (Sister Nancy).
In this study cold compress refers to the application of ice cube covered by gauze to the area
of infiltration for the duration of 15 min twice a day in the morning and evening for three
days.

Intravenous infiltration
Infiltration refers to escape of fluid in to the subcutaneous tissues due to the dislodgement or
malfunctioning of the cannula characterized by swelling, pain or itching, burning, skin that is
cool to the touch or discoloration (Whaley and Wong, 2006) .
In this study, infiltration refers to the infusion site with features of swelling, redness
tenderness and pain.

Pain:
Pain is a feeling of distress, suffering or agony, caused by stimulation of specialized nerve
endings (Bailliere’s Nurse’s Dictionary).
In this study, pain refers to subjective feeling of discomfort measured by scores of numerical
pain scale.

HYPOTHESIS

H1- There will be a significant relationship between cold compress and intensity of pain due
to intravenous infiltration
H0 - There will be no significant relationship between cold compress and intensity of pain
due to intravenous infiltration

DELIMITATION

The study is delimited to cannulated patients admitted in Era Hospital, Lucknow.

ETHICAL CONSIDERATION
The main study will be conducted after the approval of research committee permission will
be obtained from the following.
 The principal of Era College of Nursing.
 The ethical committee of Era University
 The research committee of Era University
 The Medical Superintendent of Era Hospital
 The Nursing Superintendent of Era Hospital
 Informed consent will be taken from the patients who are willing to participate in this
study.

SUMMARY
This chapter deals with introduction , need for study , problem statement , objectives
,hypothesis , operational definition , delimitation and ethical consideration.
 CHAPTER – 2
REVIEW OF LITERATURE

The review of literature entails the systematic identification, reflection, critical

analysis and report of existing information in relation to the problem of interest. Review of
research topic serves several purposes. A familiarity of previous study is useful in suggesting
research topics in identifying aspects of a problem about which more research is being done.

The investigator reviewed literature available on IV infiltration – development,

complications and management, and the effect of cold application in reducing pain.

This is classified under three sections-

Section A: Studies related to development of IV infiltration.
Section B: Studies related to management of IV infiltration.
Section C: Studies related to effectiveness of cold application in reducing pain.

Section A - Studies related to Development of IV infiltration:

Kagal EM, Rayan.GM, (2004) A retrospective study on the complications of peripheral

intravenous catheters in hand and forearm with the aim of identifying the most common sites
for developing infiltration. The records of 67 patients from Komagone city hospital were
reviewed. By using Mean and standard deviation, the study found that, there were 56 minor
complications which comprises of 26 intravenous infiltrations out of 11 major complications
as phlebitis, 6 skin necrosis, 2 compressive nerve lesions, digital stiffness is one and
compartment syndrome is one1.

Vandenbos.F et al., (2003) A descriptive study on incidence and complication of

intravenous infusion with the aim of identifying the IV related complication. The samples
were 650 patients with IV cannula from Nice University Hospital, among whom 219 were
women (46%) and 331 were men (54%). The Chi-square findings show that 54(13.6%) had
thrombophlebitis, 50(13.2%) had Infiltration and 9 (2.3%) had swelling and local infection2.
Catney MR., Hillis.S, (2001) A descriptive study on peripheral intravenous complications
and its risks with the aim to identify the relationship between peripheral intravenous catheters
dwell time and the development of phlebitis and infiltration in medical surgical units of Iowa
City. Log rank tests were used to test for an association between the covariates and the time
until failure. The Correlation findings show that, the total differences in the estimated failure
rates item. The catheter lasting 6 days versus a new catheter inserted for another 3 days is
1.3% because the conditional failure probability estimates for days 4, 5 and 6 are slightly
higher than for day 1, 2 and 33.

Mikulis.DJ et al. (2002) A descriptive study on complications of peripheral vein with the
aim to identify the causes of complications and its incidence with 50 inpatients, Toronto
Research institute, Toronto. By using mean and standard deviation, the findings stated that
infiltration and Extravasation (62%), subcutaneous hematoma (21%), spontaneous rupture of
vein (6%), obliteration of Vessel (2%), superficial phlebitis (2%), external bleeding (0.5%)
and the cause is due to incorrect techniques of insertion, placement and administration of IV
solution4.

Graham.DR, Keldermans MM, (1999) A descriptive study on infectious complications

among patients receiving home intravenous therapy with peripheral, central or peripherally
placed central venous catheters in Springfield Clinic, Illinois, with 300 patients from two
hospitals based home IVT services over 29 months. 6 bacteremia’s (one death), 2 subclavian
thrombosis, 13 catheter site infections, and 1 additional death occurred. Among PICC
patients mean duration of therapy was 24 days (0-67) and was completed in 51 patients;
others completed therapy with standard peripheral catheters a mean of 6 days later.
Complications included 17 obstructions by clot, 11 cases of phlebitis, 6 catheter fractures, 5
punctures, 2 accidental removals and 1 infiltration. They conclude that home IVT is safe via
many means of access with fewer infections than with hospital care. Such infections may be
termed “nosohusial.” 5
Section B – Studies related to Management of infiltration.

Chandravasu O et al., (2004) A study on new method for the prevention of skin sloughs and
necrosis secondary to intravenous infiltration with the aim to identify measures to prevent
secondary complication. It was descriptive study conducted in pediatric ward in Canada with
18 premature infant with IV infiltration. Independent’s’ test was used to analyze the data.
They concluded that simple multiple puncture method is proposed to prevent the infiltration
and skin sloughs6.

Yosowite.P, Ekland DA., (2003) A descriptive study on peripheral intravenous infiltration

necrosis with the aim of identifying the risk factors in relation to development of
infiltration, necrosis in Nagano Medical center, Japan. Out of 14 patients, 8 patients
received IV solution containing calcium salts and remaining 6 patients received 10%
dextrose. 5 patients developed severe disfigurement (or) impaired limb function. The
management includes debridement-8(57.5%), early skin grafting-4(28.5%) and secondary
reconstruction-2(14%).They concluded that the nurses who administering these drugs may
believe that infiltration may come serious sequelae7.

Khan.MS, Holmes JD., (2002) A descriptive study on cytotoxic extravasation and its
complications with the aim of formulating a protocol for the dilution flush out technique with
18 adult patients of extravasation after cytotoxic medication in Lebanon medical Centre.
Frequency and percentage distribution found that among 18 patients, 17 of them were treated
immediately and needed no surgical intervention where as the one patient not treated needed
a split skin graft to cover the defect8.

Handler E G., (2000) A case report on superficial compartment syndrome of the foot after
infiltration of intravenous fluid at Department of Pediatrics and Rehabilitation Medicine,
University of Wisconsin-Madison. This is a report of a four-year-old boy with a spinal cord
injury resulting in paraplegia who developed a compartment syndrome of the foot due to
intravenous fluid extravasation. The patient required surgical decompression and subsequent
skin grafting. This case report demonstrates that the normal warning signs indicative of
intravenous fluid infiltration such as pain or perception of pressure are not applicable in
patients with spinal cord injuries and that warning symptoms may not be a reliable means for
monitoring infiltrations. Intravenous lines placed in the affected limb of these patients must
be frequently visualized and evaluated9.

Section –C : Studies related to Effectiveness of Cold application in reducing

pain

Kubo.K, Kanehisa H.,(2005) A comparative study on Effects of cold and hot water
immersion on the mechanical properties of human muscle and tendon in vivo at Department
of Life Science, University of Tokyo with the aim to investigate the effects of cooling and
heating on the mechanical properties of muscle and tendon. The findings shows that after
cooling and heating, no significant changes in the elongation of muscle fascicle, tendon and
aponeurosis were found during passive stretch. Similarly, after both the immersions there
were no changes in the relationship between the estimated muscle force and elongation of
each structure (tendon-aponeurosis complex, tendon) during isometric contraction10.

Saeki.Y, (2002) A clinical trial on effect of local application of cold or hot for relief of
pricking pain with the aim to determine the effect of the application of cold or heat on the
sensation of pricking pain based on autonomic response. It was conducted at Nagano city,
Japan on 20 samples of patient with IV infiltration by using visual analog scale. Unpaired ‘t’
test was used to compare the hot and cold application in reducing pain sensation. The result
suggest that application of cold promotes relief of pricking pain sensation and suppression of
autonomic response {p<0.001] and that application of heat (p<0.01)has no such effect. 11

Thomas CS, Scott S., (2001) An experimental clinical trial study on Box jellyfish
(Carybdea alata) in Waikiki: their influx cycle plus the analgesic effect of hot and cold packs
on their stings to swimmers at the beach at Department of Family Practice, USA with the aim
to measure the analgesic effect of hot and cold packs on box jellyfish (Carybdea alata)
stings to Waikiki swimmers at the beach. Analysis of data by using paired‘t’ test showed a
minimal trend toward pain relief 10 minutes after the application of hot packs, particularly
when the initial pain was mild to moderate. Cold packs showed no clinically significant relief
of pain, compared to the control12 .

SUMMARY

This chapter deals with review of literature which is divided into three sections A , B and C .
 CHAPTER -3

RESEARCH METHDOLOGY

“Research is to see what everybody has seen and to think what nobody else has
thought”

-Albert Szent Gyogrt “Nobel price forn

medicine”(1937).

Research methodology is a way of systematically solving the research problem It

explains the steps that are generally adopted by the research in studying the research problem
along with the logic behind them this chapter deals with methodology adopted for the study it
includes research approach , research design , research settings , development of tool ,
description of tool , validity , reliability.[Suresh K Sharma]

Research methodology is define as a design or plan or strategy of a research study that

gives guidelines, which direct the research, steps the research study process and enable in
systematic data collection, logical organization and accurate data analysis and data
interpretation.

Mrs. Sunanda S. Roy Chowdhary, 2011

RESEARCH APPROACH

“Research is creating new knowledge”

-Nil Armstrong

Research approach is the umbrella that covers the basic procedure for conducting
research (Treeze & Treeze, 1996).

The research approach is a overall plan or blue print choosen to carry out the study .
the selection of research approach is the basic procedure in research enquiry.A research
approach tells as to what data to collect and how to analyses it ,it also suggest possible
conclusion to be drawn from the data. [Suresh K Shrama]

The present study will be a Quantitative Approach

RESEARCH DESIGN

Research design refers to the strategies that the researcher adopts to develop
information that is accurate, objective and meaningful. The research design incorporates
some of the most important methodology decision that the researcher makes in conducting
the study. It helps the selection of subjects, manipulation of the independent variables,
observation to be made and the statistical analysis to be used to interpret data. According to
Polit and Hungler, research design refers to the researcher’s overall plan for obtaining
answers to the research questions or for testing the research hypothesis.

The research design selected for the study is true experimental pre-test post-test
only design, as the study fulfills the criteria such as manipulation, randomization and
control. The investigator will compare the effectiveness of two interventions between
two groups.

Randomization Pretest Intervention Post test

Experimental group   
Control group  × 

SETTING OF THE STUDY

According to Polit & Beck (2008), setting is the physical location and condition in
which the data collection takes place in a study. The researcher should carefully select an
appropriate setting because it can influence the way people behave or feel and how they
respond. “The researcher needs to decide where the interventions will be implemented and
when the data will be collected.”

Setting is the location ,where the study conducted.[Suresh K Shrama]

The study will be conducted in Era Hospital, Lucknow

POPULATION

The entire set of individual or the object having the same common characteristics.
(Polit & Hungler, 1999).

It refers to aggregate on totality of all objects ,subjects or members that confirm to a

set of specification[Suresh K Sharma]
Population includes patients with signs and symptoms of intravenous infiltration
admitted in Era Hospital, Lucknow

SAMPLE

A sample is a subset of population selected to participate in the research study. “A

sample is a small proportion of a population selected for the observation and analysis”. ( Best
and J. W. 1995)
Sample refers to a subject of population that is selected to participate in a particular
study [Suresh K Sharma]
In this study sample refers to Cannulated patients with intravenous infilteration
meeting the selection criteria admitted in Era Hospital, Lucknow.

SAMPLE SIZE

60 Patients will be selected from Era hospital

CRITERIA FOR SAMPLE SELECTION

Sample where selected with the following predetermined set of criteria during the
period of study

INCLUSION CRITERIA
 Age- 20 to 45 years
 Both male and female
 Patients on continuous IV therapy
 Patient admitted with any disease.
EXCLUSION CRITERIA
 Patient undergoing Palliative care.
 Patient admitted in ICU for more than 2 weeks.
 Patients with central venous catheter.
 Patients admitted for adverse drug reactions.
 Patient who have a preexisting skin condition like dermatitis, eczema.
 Patients with neurological disorder who is not able to perceive pain.
 Patients undergoing blood transfusion
 Patients undergoing chemotherapy

SAMPLING TECHNIQUE

Sampling refers to the process of selecting a portion of population to represent the

entire population. [Suresh K Sharma]

Sampling refers to process of selecting a proportion of the population represent the

entire population. (Polit & Hungler, 1999). Sampling is necessary because it is more
economical and efficient to work with a small group of elements.

In present study non probability Convenient sampling method is used to select sample
in this study.

DATA COLLECTION TOOLS AND TECHNIQUES

Data collection tools are the devices that a researcher uses to collect data. The types of
data collection tools required depend upon the nature of the data to be gathered to answer the
research questions. A search for the data collection literature will be made for the purpose of
locating an appropriate tool. The instrument selected in a research must be a vehicle that
obtains best data for drawing conclusion of the study (Treeze & Treeze, 1996).

Data collection tools are the procedures or the instruments used by the researcher to
observe or measures key variables in research problem [Suresh K Sharma]
The tool will comprise of two parts: Section A and Section B
Section A comprises of part I and part II.
Part I - demographic variables -Age, Sex, Marital Status, Education, Occupation and
number of days of hospitalization.

Part-II – Details of IV therapy with cannula – such as location of the IV cannula, type
of IV cannula, size of IV cannula, type of IV fluid, Rate of flow during the last 24
hours, time gap between two therapy , duration of IV therapy, Disease condition,
presence of signs and symptoms of IV infiltration.

Section B comprises of pain assessment scale, which was numerical pain scale. The
scoring key for pain was categorized in to,

CONTENT VALIDITY AND RELIABILITY OF THE TOOLS

The reliability denotes the degree of consistency of the tool it was established by
using the method

The content validity will be verified by experts of various fields.

The reliability of the tools will be done after conducting the pilot study.

PILOT STUDY

Pilot study is the small scale version done in the preparation of the main study. (Polit
& Hungler).

A pilot study is the miniature of the main study. It will be conducted with the 10% of
sample with similar characteristics to that of main study to find out the feasibility of the
study, the tool and the informational booklet. The pilot study will be conducted with 10
patients, 5 in each group.

PLAN FOR DATA ANALYSIS

 Analysis of the demographic variables will be done by descriptive statistics.

 Comparison of data between the two groups will be done by using inferential
statistics by means of paired ‘t’ test and unpaired ‘t’ test.
REFRENCES
1. Kagal EM, Rayan.GM., “Intravenous Catheter Complications in the hands and
forearm”., Journal of Trauma., 2004 Jan., Vol 56(1)., Pp 123-127

2. Vandenbos.F et al., “Relevance and Complications of Intravenous Infusion at the

emergency unit at Nice University Hospital”., Journal of Infection., 2003 April.,
vol.16(3)., Pp 173-176.
3. Catney MR., Hillis.S, “Relationship between peripheral intravenous Catheter Dwell
time and the development of infiltration”, Journal of Infusion Nursing., 2001 Sep.,
Vol. 24(5), Pp 332-341.
4. Mikulis.DJ et al., “Complications of Peripheral IV Cannula”, Journal of Surgery,
2002 March., Vol. 40(6), Pp 159-162.
5. Graham.DR, Keldermans MM., “Complications of home intravenous therapy”,
American Journal of Medicine, 1999 Sep., Vol. 91(3B)., Pp 95-100.
6. Chandravasu O et al., “A New Method for the prevention of Skin Sloughs and
Necrosis Secondary to Intravenous Infiltration”, American Journal of Perinatology.,
2004 March., Vol 3(4)., Pp 17-24.
7. Yosowite.P, Ekland DA., “Peripheral Intravenous Infiltration Necrosis”, American
Journal of Surgery, 2003 Nov. Vol. 182(5), Pp 553-556.
8. Khan.MS, Holmes JD., “Reducing the morbidity from extravasation injuries”, Annals
of plastic Surgery, 2002 June, Vol. 17(3), Pp 36-48.
9. Handler E G., “Superficial Compartment Syndrome of the Foot after infiltration of
intravenous fluid”, Journal of Physical Medicine Rehabilitation., 2000 Jan.,
vol.71(1)., Pp 58-59.
10. Kubo.K, Kanehisa H., “Effects of Cold and hot water immersion on the mechanical
properties of human muscle & tendon in Vivo”, Journal of Clinical Nursing., 2005
March., Vol. 20(3), Pp 291-300.
11. Saeki.Y, “Effect of Local Application of Cold (or) heat for relief of pricking pain”,
2002 Sep., Vol .4(3), Pp 97-105.
12. Thomas CS, Scott S., “Analgesic Effect of hot and cold Pac, Hawaii Medical
Journal., 2001 April, Vol. 60(4), Pp 100-107.