Effects of Vibration and Breathing Exercises on Pain and Anxiety During Chest Tube Removal

Chest tube removal is a necessary clinical procedure following thoracic surgery, but it is frequently associated with acute pain and heightened anxiety. These symptoms may negatively affect patient comfort, cooperation, and recovery. While pharmacological interventions are commonly used to manage procedure-related pain and anxiety, concerns regarding side effects and limited effectiveness have increased interest in non-pharmacological approaches within nursing care.

This randomized controlled study is designed to evaluate the effectiveness of vibration and breathing exercises applied prior to chest tube removal on pain and anxiety levels. Eligible adult patients hospitalized in a thoracic surgery unit and scheduled for chest tube removal will be randomly assigned to one of three groups: a vibration group, a breathing exercise group, or a control group receiving routine care. Randomization will be performed using a web-based randomization tool to ensure equal allocation.

In the vibration group, a portable vibration device will be applied to the area proximal to the chest tube insertion site for a standardized duration before the removal procedure. In the breathing exercise group, participants will be guided through structured breathing exercises designed to promote relaxation and diaphragmatic breathing. The control group will receive standard clinical care without any additional non-pharmacological intervention.

Pain intensity and anxiety levels will be assessed at two time points: prior to the chest tube removal procedure and shortly after the procedure. Validated measurement tools will be used to ensure reliability of the findings. Data will be analyzed to compare changes in pain and anxiety levels within and between groups.

The results of this study are expected to provide evidence regarding the use of vibration and breathing exercises as simple, safe, and cost-effective nursing interventions to reduce pain and anxiety associated with chest tube removal. These findings may contribute to the development of evidence-based, non-pharmacological strategies in clinical nursing practice.

• Vibration (Other): Vibration will be applied using a portable data device inserted for a standard duration, combined with chest tube placement. The procedure will be performed with the patient in a comfortable position.
• Breathing Exercises (Other): The remaining patients will be given breathing exercises including slow, deep, diaphragmatic, and iced-lip breathing techniques. These exercises will be performed calmly and quietly by the researcher to promote relaxation. The combined intervention will continue in addition to routine clinical care until the procedures and chest tube removal expense are completed.

Primary outcomes

• Pain Intensity [Assessed immediately before chest tube removal and 10 minutes after the procedure.]: Pain intensity associated with chest tube removal will be assessed using the Visual Analog Scale (VAS), a validated 10-cm scale ranging from 0 (no pain) to 10 (worst imaginable pain). Participants will self-report their pain level.

Secondary outcomes

• Anxiety Level [Assessed immediately before chest tube removal and 10 minutes after the procedure.]: Anxiety levels will be measured using the State Anxiety Inventory (State-Trait Anxiety Inventory - State subscale), a validated self-report questionnaire designed to assess situational anxiety. Higher scores indicate higher levels of anxiety.

Sex: All, ages: 18 Years to 65 Years

Inclusion criteria

* 18 years of age and older,
* Conscious, oriented, and cooperative (e.g., Glasgow Coma Score ≥ 13),
* Able to speak and understand Turkish,
* Having a chest tube and undergoing chest tube removal for the first time,
* Hemodynamically stable,
* Having not taken analgesic, sedative, or anxiolytic drugs at least 4 hours prior to the procedure,
* Able to communicate and respond to pain assessment scales during the procedure,
* No severe hearing, visual, or communication impairment,
* No neurological or cognitive disease that could affect the assessment of cognitive functions,
* No history of psychiatric diagnosis or active psychiatric treatment,
* Patients who voluntarily participate in the study and provide written consent will be included.

Exclusion criteria

* Patients with past or current cognitive and psychological disorders,
* Those who have previously had chest tube insertion,
* Those who are mechanically ventilated (intubated),
* Those who have chronic pain and routinely use analgesics,
* Those who used analgesics immediately before chest tube removal,
* Those who did not volunteer to participate in the study.