Effect of Cold Application on Pain, Ecchymosis, and Comfort After Transradial Coronary Angiography

This randomized controlled experimental study aimed to determine the effect of cold application after transradial coronary angiography on patients' pain, bruising (ecchymosis), comfort levels, and the duration of TR band placement. The study was conducted in the coronary intensive care unit (ICU) of a university hospital in Istanbul, Türkiye, between July 2023 and July 2024.

A total of 104 adult patients who underwent transradial coronary angiography and were monitored with a TR band for bleeding control were included. Patients were randomly assigned to intervention (cold application) and control groups using a computer-generated simple randomization method.

In the intervention group, cold packs prepared by placing gel compresses in a freezer for 2-3 hours were applied to the wrist area. Cold application started immediately after admission to the coronary ICU and was performed for 15 minutes every hour until the TR band was removed. After the TR band was removed, cold application continued every 2 hours for 15 minutes. The control group received routine post-procedural care without cold application.

Pain levels were assessed hourly using the Numerical Rating Scale (NRS). Bruising was monitored by measuring the hematoma size using a ruler and marking its borders on the skin to track changes. Patient comfort was evaluated twice: at ICU admission and when the TR band was removed, using the Early Postoperative Comfort Scale (EPCS). Laboratory values (aPTT, PT, hemoglobin, hematocrit, platelets) were collected from patients' routine clinical results before and after the procedure.

The primary outcomes of the study were pain, ecchymosis, and comfort levels. The secondary outcome was the duration of TR band placement.

The study hypotheses were as follows:

Cold application after transradial coronary angiography is effective in reducing pain levels.

Cold application reduces the development of ecchymosis.

Cold application improves patient comfort.

Cold application shortens the duration of TR band placement.

The study aimed to provide evidence on the effectiveness of a simple, non-pharmacological intervention - cold application - to improve post-procedural comfort and reduce complications in patients undergoing transradial coronary angiography.

Inclusion criteria

• Receiving care in the coronary ICU during the study period
• Underwent elective transradial coronary angiography
• Age ≥ 18 years
• Haemodynamically stable
• Conscious and able to communicate, without paresis
• Baseline pain score ≥ 3 at ICU admission (0 hour) on the Numerical Rating Scale (0-10)
• No pre-existing hematoma or ecchymosis at the puncture site
• Platelet count within the institutional reference range
• TR Band used for haemostasis after the procedure

Exclusion criteria

• Femoral or brachial arterial access used for coronary angiography
• Local infection or skin lesion at the puncture site
• Known coagulopathy, documented coagulation disorder, or active bleeding
• Undergoing an emergency procedure
• Loss of consciousness or inability to communicate
• Baseline pain score < 3 at ICU admission (0 hour) on the Numerical Rating Scale (0-10)