The Effect of Foot Reflexology on Pain Severity Associated With Mediastinal Chest Drain Removal in Patients Undergoing Open-Heart Surgery

Cardiovascular disease (CVD) is a general term for conditions affecting the heart or blood vessels. It is commonly associated with an increased risk of blood clots and build-up of fatty deposits inside the arteries. CVD is the leading global cause of death accounting for more than 17.9 million deaths per year in 2019, representing 32% of all global deaths. Of these deaths, 85% were due to heart attack and stroke (World Health Organization [WHO], 2021). Mortality rate due to CVD is expected to grow to more than 23.6 million by 2030 (American Heart Association [AHA], 2017). In Egypt, the CVD mortality rate accounts for 46% of total deaths from all ages for both sexes (WHO, 2014).

There are many options for treating CVD, one of these options is open-heart surgery (OHS) especially coronary artery bypass graft (CABG) and valvular surgeries. CABG is done in patients with severe narrowing of the coronary arteries that do not respond to other treatment. Patients after OHS are usually transferred to the intensive care unit (ICU) to receive advanced medical care and close monitoring. They may suffer pain after OHS for various reasons including sternum incision, tissue excision, removal of saphenous vein, and the presence of chest drain as well as various factors related to the type of operation). Patients in the ICU are also exposed to many invasive and noninvasive painful procedures for diagnostic or therapeutic purposes.

Mediastinal chest drain placement (MCDP) and removal is one of these painful procedures. MCDP is a part from the standard care in cardiac surgery to assist the clearance of blood from the pericardial space. The mediastinum is the region between the pleural sacs, containing the heart and all of the thoracic viscera except the lungs. Drainage of fluid, or blood from the pericardial space after OHS is necessary to prevent complications as pericardium effusions and cardiac tamponade. It also helps to detect hemorrhage. Therefore, negative pressure drain is placed in the mediastinum .

Cardiac tamponade may occur after OHS as a result of blood or fluid collecting in the pericardial space compressing the heart and reducing cardiac output. However, mediastinal chest drain removal (MCDR) is a standardized potentially painful procedure that is commonly associated with pain and can be the worst hospital experience for those patients. MCDP after OHS is traditionally achieved using large-bore (28-36 Fr) plastic chest tubes for the first 24 hours after surgery or until drainage is minimal. MCDR reduces pain and improves the forced expiratory volume in one second. Therefore, it can improve the patients' fast recovery.

Separation of the drain from the adjoined tissues is painful as it adheres to the surrounding tissues. Sternal pain is a prevalent complication caused by CABG, which normally initiates within a few hours after surgery, and with poor control it is likely to predispose the patients to chronic pains lasting for six months to one year postoperatively.