PROCEDURAL PAIN AND FEAR IN NON-HEALING WOUNDS AFTER STERNOTOMY

A. Javurkova^1|2, P. Ptacnikova^1|3, J. Raudenska¹ | ¹Department of Nursing, 2^nd Faculty of Medicine, Charles University, Prague, Czech Republic; ²Department of Clinical Psychology, University Hospital Kralovske Vinohrady, Prague, Czech Republic ³Department of Cardiac Surgery, Institute of Clinical and Experimental Medicine, Prague, Czech Republic

Abstract

Background and Aims. The aim of the study was to investigate procedural pain and pain-related fear during canister exchange in patients with a V.A.C. (Vacuum Assisted Closure) on a sternotomy wound system.
Methods. Data collection took place from 5/2025 to 2/2026 at the Department of Cardiac Surgery, Institute of Clinical and Experimental Medicine, in Prague, after approval by the ethics committee. The criteria for inclusion in data collection were adulthood, signed informed consent, knowledge of the Czech language, and first replacement of the V.A.C. canister, which was implanted due to a non-healing wound after sternotomy. The following methods were used: anamnestic data, numerical rating scale (NRS), and adult facial anxiety scale (AFAS, McCormack, 1988).
Results. N = 47 patients were examined (mean age M = 65.25, SD = 10.25, 59% men). Patients were at M = 5.17, SD = 24.21 months after the cardiac surgery. According to the intensity of procedural pain, we divided the patients into two groups: G1 mild pain NRS 0-3 (n = 39) and G2 moderate-to-severe pain NRS > 4 (n = 9). The groups significantly differed in the level of fear (AFAS) before and after canister replacement (ps < 0.001). The intensity of procedural pain was moderate before the procedure (rs = -0.322, p = 0.027). Anticipated pain significantly increases the likelihood of moderate to severe procedural pain in our sample (OR = 6.9093, 95% CI: 2.0852–22.8943).
Conclusions. It is important to prevent pain-related fear during procedural pain associated with a non-healing sternotomy wound in adults using psychological approaches.