Introduction: Intravenous injection is an essential invasive procedure for administering fluid or medications. Inpatients experience pain due to needle insertion during intravenous injection, but this is considered a short-term, non-serious treatment method and is being performed without appropriate treatment for pain reduction. However, for the comfort of the patient, efforts are required to reduce pain and stress that occur during intravenous injection. In previous studies, cold therapy and warm therapy were tried as part of an effort to reduce pain and stress during intravenous injection, and it was reported that they were effective to some extent. Therefore, in this study, an attempt was made to confirm the pain relief effect of intravenous injection by applying cold and warm therapy using a flexible thermoelectric device as a method of applying cold and warm therapy.
Methods: This study was a randomized controlled trial, and as an experimental intervention, Modified Thermoelectric Element Tourniquet (M-TEE Tourniquet), which increased the area of the plate that can transfer heat and cold using a flexible thermoelectric element, was applied. Study participants were adults who were hospitalized and had an 18-guage angiocatheter inserted intravenously in preparation for surgery. Participants in the study were recruited through recruitment announcements within the institution, and a total of 59 people participated in the study, including 20 in the warm therapy group, 20 in the cold therapy group, and 19 in the control group. As an experimental intervention, M-TEE Tourniquet was applied 10 to 12 cm above the intended intravenous injection site, and warm therapy (40 to 45 °C) and cold therapy (0 to 10 °C) were provided to each group. In the control group, M-TEE Tourniquet was applied only as a tourniquet without applying temperature. As an outcome variable, pain during intravenous injection was measured by NRS (Numeric Rating Scale), and peripheral oxygen saturation and pulse rate were measured. Perceived stress was measured by NRS. Blood flow was measured before and during application of warm and cold therapy in the same vein in the arm opposite to the intravenous injection site. After intravenous injection, the study participants and intravenous injection practitioners were surveyed on the satisfaction of using M-TEE Tourniquet.
Results: As a result of the study, there was a significant difference between the three groups in the pain perceived during intravenous injection (F=3.382, p=.041), and in particular, the cold therapy group showed lower pain than the control group (p=.036). There was no significant difference between the three groups in observed oxygen saturation (F=0.701, p=.500), pulse rate (F=0.520, p=.597), and perceived stress (F=2.359, p=.104). For blood flow, there was a significant difference in venous blood flow measured before and during application of warm therapy (F=5.991, p=.004), but there was no significant difference in arterial blood flow. There was a significant difference in participant satisfaction among the three groups (F=3.258, p=.046), and as a result of the post-hoc analysis, the satisfaction of the cold therapy group was higher than that of the control group (p=.040). There was a significant difference (F=24.137, p<.001) between the three groups in intravenous injection practitioner’s satisfaction, and as a result of post-hoc analysis, both the warm therapy group and the cold therapy group were significantly higher than the control group (p<.001).
Conclusion: In conclusion, it was found that M-TEE Tourniquet has the effect of relieving intravenous injection pain and increasing the satisfaction of patients in cold therapy, and also increases the satisfaction of intravenous injection practitioners. However, since the evidence for application time, application area size, and application temperature is lacking, a rigorous study on this should be conducted.

정맥 주사는 수액요법이나 주사제 치료를 위해 이루어지는 필수적 침습적 처치이다. 입원 환자들은 정맥 주사 시 바늘 삽입으로 인한 통증을 경험하지만 이는 짧은 시간 진행되는, 그렇게 심하지 않은 치료 방법으로 생각하여 통증 감소를 위한 적절한 처치 없이 행해지고 있다. 그러나 환자의 안위를 위해서 정맥 주사 시 발생하는 통증 및 스트레스를 감소시키기 위한 노력이 필요하다. 선행연구에서 냉요법, 온요법은 정맥 주사 중 발생하는 통증 및 스트레스를 감소시키기 위한 노력의 일환으로 시도되었으며, 어느 정도 효과적이었다고 보고하였다. 그러므로 본 연구에서는 냉요법, 온요법을 적용하는 방법으로 유연열전소자를 이용하여 냉과 온요법을 적용하고 정맥 주사 통증 완화 효과를 확인하기 위하여 시도되었다.
본 연구는 무작위 통제 시험이었으며, 실험 중재로 유연열전소자를 이용하여 열과 냉을 전달할 수 있는 plate의 면적을 증가시킨 Modified Thermoelectric Element Tourniquet (M-TEE Tourniquet)를 적용하였다. 연구 참여자는 입원한 환자 중 수술 준비로 18 Guage Angiocatheter를 정맥 내에 삽입하는 성인이었다. 연구 참여자는 기관 내 모집공고를 통해 모집하였으며, 온요법군 20명, 냉요법군 20명, 대조군 19명으로 총 59명이 연구에 참여하였다. 실험 중재로 정맥 주사 예정부위에서 10~12cm 위에 M-TEE Tourniquet을 적용시키고 각 군별로 온요법(40~45℃)과 냉요법(0~10℃)을 제공하였다. 대조군은 M-TEE Tourniquet을 온도를 적용하지 않은 상태로 토니켓으로만 적용하였다. 결과변수로 정맥 주사 중 통증은 지각된 통증 점수를 NRS(Numeric Rating Scale)로 측정하였고 말초산소포화도와 맥박수를 측정하였다. 지각된 스트레스 지수를 NRS로 측정하였다. 정맥주사 부위 반대 팔에 있는 동일 혈관에서 온요법과 냉요법 적용 전과 적용 중의 혈류를 측정하였다. 정맥 주사 후 연구 참여자와 정맥 주사 시행자에게 M-TEE Tourniquet 사용 만족도를 조사하였다.
연구 결과 정맥 주사 시 지각된 통증(F=3.382, p=.041)은 세 군간 유의한 차이가 있었으며 특히 냉요법군이 대조군보다 통증이 낮은 것으로 나타났다(p=.036). 관찰된 산소포화도(F=0.701, p=.500)와 맥박(F=0.520, p=.597), 지각된 스트레스(F=2.359, p=.104)는 세 군간 유의한 차이가 없었다. 혈류는 온요법 적용 전과 적용 중에 측정한 정맥 혈류 흐름의 차이(F=5.991, p=.004)에서 유의한 차이가 있었으나 동맥 혈류 흐름에는 유의한 차이가 없었다. 참여자 만족도는 세 군간 유의한 차이(F=3.258, p=.046)가 있었으며, 사후분석 결과, 냉요법군의 만족도가 대조군의 만족도보다 높은 것으로 나타났다(p=.040). 정맥주사 시행자 만족도는 세 군간 유의한 차이(F=24.137, p<.001)가 있었으며, 사후분석 결과, 온요법군, 냉요법군 모두 대조군보다 유의하게 높았다(p<.001).
결론적으로 M-TEE Tourniquet은 냉요법에서 환자의 정맥주사 통증 완화 효과 및 만족도 상승효과가 있으며, 정맥 주사 시행자의 만족도도 증가시키는 것으로 나타났다. 그러나 적용 시간, 적용 면적 크기, 적용 온도에 대한 근거가 부족하므로, 이에 대한 엄밀한 연구가 수행되어야 한다.

• 국문요지 = ⅰ
• 차례 = ⅳ
• Ⅰ. 서론 = 1
• 1. 연구의 필요성 = 1
• 2. 연구목적 = 6
• 3. 연구가설 = 7
• 4. 용어정의 = 9
• Ⅱ. 문헌 고찰 = 15
• 1. 정맥 주사시 통증 = 15
• 2. 통증 완화를 위한 중재 = 18
• Ⅲ. 이론적 기틀 = 22
• Ⅳ. 연구 방법 = 25
• 1. 연구설계 = 25
• 2. 연구대상 = 26
• 3. 연구도구 = 31
• 4. 실험처치 = 36
• 5. 자료수집 기간 및 절차 = 46
• 6. 자료분석 방법 = 50
• 7. 윤리적 고려 = 51
• Ⅴ. 연구 결과 = 52
• 1. 대상자의 사전 동질성 검증 = 52
• 2. M-TEE Tourniquet이 정맥 주사 시 통증에 미치는 효과 = 58
• 3. M-TEE Tourniquet이 정맥 주사 시 스트레스에 미치는 효과 = 68
• 4. M-TEE Tourniquet이 정맥 주사 시 혈류에 미치는 효과 = 72
• 5. M-TEE Tourniquet이 정맥 주사 시 대상자 만족도에 미치는 효과 = 78
• 6. M-TEE Tourniquet이 정맥 주사 시 시행자 만족도에 미치는 효과 = 80
• Ⅵ. 논의 = 82
• Ⅶ. 결론 및 제언 = 85
• 참고문헌 = 90
• 부록 = 94
• ABSTRACT = 104

1. Pain & Electrical Therapy, Jung IS, Kim JU, 17(1):4-22, , 2019

2. Thermoelectric element Trends, Jeon HS, Moon SE, 2:144-153, , 2015

3. Interpersonal aspects of nursing, Dugan, Anna B., 3(1):14-15, , 1973

4. Child and adolescent health nursing, Ha YS, Lee JH, Kim SH, Kim SH, Kim SJ, Kim YY, 313-353 p, , 2019

5. Application trends in thermoelectric materials, Chun HW, Moon SE, 30(1):144-153, , 2015

6. Domestic and foreign thermoelectric device research trends, Jo BJ, 25(2):38-47, , 2012

7. Effects of topical anesthetic cream on pain at venipuncture in children, Kim YS, Park HR, 20(3):142-148. https://doi. org/10.4094/chnr.2014.20.3.142, , 2014

8. The effect of hearing music on pain response during blood sampling in neonates, Oh HL, Yang EJ, Lee HJ, Park HK, Kim CR, 20(4):470-475. https://libra. cnu. ac. kr/_Lib_Proxy_Url/https://koreamed. org/SearchBasic. php?RID=1876433, , 2013

9. The effect of topical EMLA cream for venipuncture on patients' pain and anxiety, Kim JK, Shim MS, Kim KH, 13(9):4065-4072, , 2012

10. Effectiveness of virtual reality for pediatric pain distraction during IV placement, Jeffrey I. Gold, Kim SH, Alexis J. Kant,, 9 (2):207. https://doi. org/10.1089/cpb.2006.9.207, , 2006

11. Effect of distraction on hospitalized children's fear of hospital and needle-related pain, Jo SM, Ahn H., 19:684-692. https://doi. org/10.5977/jkasne.2013.19.4.684, , 2013

12. Implementation of blood flow speed detection system using single-gate pulsed doppler system, Kim NW, Suwon: Ajou University, , 2002

13. Development of evidence-based nursing practice guidelines for cold application in adult care, Lee YY, Kim HJ, An JW, Shin YS, 30(3):325-345. https://doi. org/10.7475/kjan.2018.30.3.325, , 2018

14. The effects of character distraction on intravenous injection pain of hospitalized preschooler, Cho KJ, Lim OW, 12(2):215-222, , 2006

15. Comparrison of topical EMLA Cream and 1% lidocaine infiltration for radial arterial cannulation, Yoon SH, Hwang WJ, Choi SJ, 22(2):517-522, , 1995

16. Effects of vibration and cold application on pain and anxiety during intravenous catheterization, Çetin SP Çevik K., 34(4):701-709. https://doi. org/10.1016/j. jopan.2018.12.005, , 2019

17. Satisfaction: A behavioral perspective on the consumer: A behavioral perspective on the consumer, Oliver RL, 2nd ed, , 2014

18. A comparison of effect on pain relief between lidocaine and placebo ointment group for phlebotomy, Min YS, Im JM, 2013(1):53. https://kiss-kstudy-com. libra. cnu. ac. kr/Detail/Ar?key=3425112, , 2013

19. Assessment of the influence of application time of lidocaine patch on pain intensity after venipuncture, No IS, Kim SY, 25(4):250-258. https://doi. org/10.7739/jkafn.2018.25.4.250, , 2018

20. Effects of distraction by an animation on pain and fear during venipuncture of hospitalized preschool children, Jeong KI, Bae YS, Lee JW, 12(2):865-875, , 2010

21. Effects of distraction by a smart phone on pain and fear during venipunture for hospitalized preschool children, Kim JM, Park HJ, Yang YO, 15(3):1391-1402, , 2013

22. The effect on ice application and distraction on arterioveneous shunt injection pain of hemodialysis is patient, Jang AK, Master's thesis Seoul, , 2000

23. Effects of active and passive distraction intervention on pain responses of preschool children during immunization, Im ES, Kim JS, 16(12):102, , 2016

24. A Study to evaluate the efficacy of 9.6% lidocaine of local anesthesia for pain reduction of venipuncture in the ED, Park D, Ryu JY,, 20(2):115-118, , 2007

25. The effect of structured cryotherapy on edema, inflammation and pain in postoperative patients with ankle fractures, Song JY, Shon KH, Kim NH, 8(11):399-413, , 2018

26. A comparative study on the effectiveness of symptom control between heat and cold therapy in patients with arthritis, Kang HS, 2(2):147-159, , 1995

27. Effects of lidocaine patch application to decrease pain and fear during blood sugar test in elderly patients with DM, Kim SY Kim J, No IS, 23(1):12-20. http://doi. org/10.7739/jkafn.2016.23.1.12, , 2016

28. Heat application according to nurse's belief on evidence-based practice and behavioral intention related to research, Yoon SK, Shin YS, 23(3):264-274. https://doi. org/10.7739/jkafn.2016.23.3.264, , 2016

29. Effect of local cold therapy on arterial blood oxygen saturation and temperature changes in patients undergoing surgery, Miri A, Masoudi R, Roshanzadeh Ma, Davoodvand S., Kheiri S, 10(3):1. http://dx. doi. org/10.5812/msnj.11734\, , 2021

30. The study of promoting method for VR contents to reduce pain of child patient - focusing on the case studies of VR contents at home and abroad, Kim HD, Joo AR, 20(6):167-176, , 2020

31. Comparison of the degree of pain according to nursing intervention method during arteriovenous fistula needle insertion for patients on hemodialysis, Yu YM, Moon SM, Kim JY, Bae HJ, Ha HR, 17(2):286-296, , 2011

32. Effect and satisfaction of repeat training of aroma inhalation therapy on pain and stress in arteriovenous fistula puncture in hemodialysis patients, Song HY, 4(3):115-129. https://libra. cnu. ac. kr/_Lib_Proxy_Url/https://www. earticle. net/Article/A418069, , 2022

33. Effects of 10 % lidocaine spray and aroma hand massage on pain,anxiety, blood pressure, and pulse during arteriovenous fistula needling in hemodialysis patients, Song JM, Park HJ, 19(1):1-11, , 2016

34. The comparison of effects of 2% lidocaine intradermal injection and 10% lidocaine spray for pain and anxiety relief on arteriovenous fistula puncture in hemodialysis patients, Lee YH, Kim NC, 13(2):169-177, , 2007