International Journal of Advanced Research and Development 35 International Journal of Advanced Research and Development ISSN: 2455-4030, Impact Factor: RJIF 5.24 www.advancedjournal.com Volume 2; Issue 3; May 2017; Page No. 35-42 The effect of cutaneous stimulation on pain perception at arterial puncture site among critically Ill patients in Menoufia University Hospital Omima Said MH Shehata, Om Elhana Kamel A Abo Shehata Lecturer, Medical Surgical Nursing Department, Faculty of Nursing, Menoufia University, Egypt Abstract Pain caused by some therapeutic and nursing procedures has been a major concern of health care providers and arterial puncture is one of the most painful procedures for many hospitalized patients. So pain management is critical issue in the purview of all health professionals especially nurses because it is an important component of comprehensive nursing care. Nursing efforts should be made to assess and manage acute pain inflicted by insertion of needle in arterial puncture sites among critically ill patients. Aim of the current study was carried out to examine the effect of cutaneous stimulation on pain perception at arterial puncture site among critically ill patients in intensive care units at Menoufia University hospital. Sample: A random sample of hundred critically ill patients who undergoing arterial puncture. The study group (n=50) received cutaneous stimulation plus routine hospital care for pain management before arterial puncture, whereas the control group (n=50) received hospital care for pain management only. Tools: four tools were utilized to collect the data. Tool I: An interviewing questionnaire to assess sociodemographic and clinical data. Tool II: Physiological measure sheet. Tool III: a Visual Analog Scale, and Tool IV: Critical- Care Pain Observation Tool. Results: reveled that there were a statistically significant differences between study and control group related to pain perception of patients in terms of pain score immediately the puncture as well as 5 minutes after the puncture. Conclusions: Cutaneous stimulation is effective in reducing pain perception at arterial puncture site among critically ill patients. Keywords: effect, cutaneous stimulation, pain perception and critically ill 1. Introduction Critically ill patients require quick decision making that can mean the difference between life and death. One laboratory test that enhances such decision making is arterial blood gas (ABG) analysis. The results of the analysis allow practitioners to immediately assess a patient’s oxygenation status, carbon dioxide levels, and acid-base balance. In order to obtain blood samples for ABG analysis from a patient who does not have a central circulatory or arterial access, an arterial puncture must be performed [1] Except for intravenous therapy, arterial access is the most common invasive procedure performed on critically ill patients. Arterial puncture is a source of pain and discomfort in critical care. Although pain cannot be completely eliminated during invasive procedures such as obtaining blood from an artery, pain should be minimized [2, 3] . Moreover, Matheson, et al [4] Malley [5] Hudson, et al. [6] and Sawyer [7] reported that arterial puncture is one of the most common laboratory procedures used in hospitalized patients. Although this invasive procedure is associated with moderately to severely pain and discomfort, are frequently performed by clinicians/nurses without any pain management. Strategies for pain management include pharmacological and nonpharmacological intervention. The nonpharmacological approaches are essential component of pain relieve that include relaxation technique, visual imagery, behavioral- cognitive strategies and biophysical interventions such as massage, pressure, and cutaneous stimulation through either heat or cold application. Although most of nurses have a commitment in pain reduction, fewer of them work for alleviation. Effort on pain management from health professionals at all department levels should be implemented as an important measure toward changing ineffective pain management practices [8] . Cutaneous stimulation is defined as stimulation of the skin and underlying tissues for the purpose of decreasing undesirable signs and symptoms such as pain. It also referred to as peripheral technique; describe any form of stimulation of the skin with the goal of pain relief. There are many different methods of cutaneous stimulation such as pressure, massage, heat and/ or cold application. Research evidence show that cutaneous stimulation is an independent nursing intervention that advocated relieving pain and the nurse in practice is qualified to give it accurately [9] . Nursing is a profession based on art and science. This means that a professional nurse learns to deliver care artfully with compassion. Care should always change with new discoveries and innovations. When nurses integrate the science and art of nursing into their practice, the quality of care provided to the patients is at a level of excellence that benefits in innumerable ways. Intensive care unit (ICU) provides care to patients who are seriously ill and require 24- hour care and monitoring [10-11] . In the last not the end, pain is one of the most frequently used nursing diagnoses. Looking for and test applicable pain management techniques are the highest responsibility of the nurses. Precise assessment is crucial in determining the usefulness of the therapies that are used for pain control. In order to provide holistic care, it is the responsibility of the