الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Patients undergoing thoracic surgery require placement of at least one chest tube. This chest tube is very important in the postoperative period to remove air, fluid, or blood from the pleural space, prevent cardiac tamponade after open heart surgery, prevent lung collapse after thoracic surgery and promote adequate gas exchange. Chest tubes can cause the patient a great deal of discomfort as they can inhibit chest expansion, which could prevent the patient from breathing effectively or removing trapped secretions. Removal of the chest tubes is obviously more comfortable for the patients and enables them to move and breathe with less discomfort. Removal of these chest tubes has been described as one of the worst ICU experiences for these patients.
CTR pain may severely impair the ability of patient to ventilate and to clear secretions in a normal manner. This leads to a restrictive pulmonary defect with a significant decrease in VC and in FRC. These put the patient at increased risk of perioperative complications; physical (cardiovascular and respiratory system complications) and psychological complications. These complications can be prevented by effective chest tube removal pain control with superficial cooling.
Chest tube removal pain control is a multifaceted area of professional practice which considers an important part of the collaborative management for the thoracotomy patients. It is vital and significant for patients’ outcome and health restoration. Superficial cooling can improve patient comfort during chest tube removal that has physiological and psychological benefits for thoracotomy patients.
The critical care nurse is responsible for all patients’ care; the nurse has a vital role in the preoperative and postoperative care for thoracotomy patients. Patient’s comfort is an integral part for thoracotomy patient during the postoperative period. So the critical care nurse must be competent in relieving any factor can alter patient’s comfort during this critical period. Chest tube removal can induce moderate to severe pain for patient, so the nurse is the most responsible person for assessing the pain level during different CTR pain assessment times in order to conduct an effective care. This care is very useful in the reduction of the incidence and severity of physical and psychological complications during postoperative period. It also reduces incidence of morbidity and mortality that promote early recovery and reduce length of stay in ICU. The nursing care for those patients postoperatively is equal in importance to the operation itself.