IOSR Journal of Nursing and Health Science (IOSR-JNHS) e-ISSN: 2320–1959.p- ISSN: 2320–1940 Volume 8, Issue 1 Ver. II. (Jan. - Feb .2019), PP 88-98 www.iosrjournals.org DOI: 10.9790/1959-0801028898 www.iosrjournals.org 88 | Page Effect of Thermo-Mechanical Stimulation on Pain Associating Venipuncture among Children with Leukemia NehadSabry Basiouny 1 -Nagwa Ibrahim Hamad 2 Assistant Professor of Pediatric Nursing, Faculty of Nursing, Alexandria University 1 Lecturer of Pediatric Nursing, Faculty of Nursing, Alexandria University 2 Corresponding Author: NehadSabryBasiouny Abstract Background: Pain has been reported as a significant problem for children with leukemia as they regularly experience pain as a result of the disease, side effects of treatment and painful procedures associated with medical management. Children often perceive invasive medical procedures as worse than the disease itself for which they are being treated. So, it is reasonable to address their pain by incorporating non-pharmacological intervention as thermo-mechanical stimulation. Thermo-mechanical stimulation is a non-pharmacological technique that reduces venipuncture pain by combining vibration, cold therapy and distraction. Aim: The aim of this study was to determine the effect of thermo-mechanical stimulation on pain associating venipuncture among children with leukemia. Research Design: A quasi- experimental research design was used. Setting: The study was conducted at the Outpatient Hematology/Oncology Unit of Alexandria University Children’s Hospital at Smouha.Subjects: A convenience sampling of 80 preschool children with leukemia who were visiting the previously mentioned setting for blood sampling or receiving chemotherapy. The study subjects fulfilled the following criteria: age ranged from 3 to 6 years,free from sickle cell disorder and did not receive any analgesics before venipuncture. Tools: Three tools were used to collect necessary data, namely; Children’s Characteristics and Medical History Tool, Children’s Physiological Parameters Record and FLACC (Face, Leg, Activity, Cry and Consolability) Pain Assessment Tool. Results: The main study findings showed that 80% of children in the study group were relaxed and comfortable during venipuncture compared to none of children in the control group. Furthermore, more than half of children in the control group (55%) exhibited severe pain during venipuncture compared to none of children in the study group. On the other hand, all of children in the study group were relaxed and comfortable after venipuncture compared to only 7.5% of children in the control group. Meanwhile, more than two-thirds of children in the control group (67.5%) exhibited moderate pain after venipuncture compared to none of children in the study group. High statistical significant differences were found between the study and control groups regarding the total pain score during and after venipuncture. Conclusion: It can be concluded that thermo-mechanical stimulation was effective in reducing pain responses during and after venipuncture among children with leukemia. Recommendation: The main recommendation of the current study was incorporating thermo-mechanical stimulation as non-pharmacological pain relief measure for children with leukemia in the Outpatient Oncology departments. Keywords: thermo-mechanical stimulation; Cold therapy; Vibration; Venipuncture; Pain; Leukemia. --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 26-12-2018 Date of acceptance: 09-01-2019 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Leukemia is the most common malignancy in early childhood. It is cancer of the hematopoietic (blood forming) system which occurs when immature white blood cells that are produced in the bone marrow keep multiplying (1, 2) . The most frequent presenting signs and symptoms of leukemia are a result of bone marrow infiltration (3) . The three main consequences are anemia from decreased red blood cells, infection from neutropenia, and bleeding from decreased platelet production. The invasion of the bone marrow with leukemic cells gradually causes weakening of the bone and tendency toward fractures. While, invasion of the periosteum leads to increased pressure and severe pain (2,3) . The spleen, liver, and lymph glands demonstrate marked infiltration, enlargement and eventually fibrosis. Involvement of the central nervous system also occurs secondary to leukemic infiltration, which may cause increased intracranial pressure (3) . According to the American Cancer Society (2016) (4) , leukemia accounts for one out of three cases of childhood cancer. The two major subtypes of children`s leukemia are acute lymphoblastic leukemia and acute myeloid leukemia, which account for 80% and 17% of all diagnosed leukemias respectively (4) . Leukemia is one of the most common ten malignancies in Egypt and the total mortality rate was 5.5 per 100, 000 populations according to the World Health Organization (2014) (5) .