Injeksi Aquadesh Utk Nyeri
Injeksi Aquadesh Utk Nyeri
Injeksi Aquadesh Utk Nyeri
There have been three systematic reviews of RCT’s skin however the depth of subcutaneous tissue is
covering complementary and alternative medicine determined by body weight. Both the needle angle and the studies on labouring women used four injections
(CAM) in obstetrics which have included the needle length are determined by the woman’s body except Bahasadri et al. (2006) who used one and
technique of sterile water injections for the relief weight. For example, the angle is determined by the Mårtensson et al.(2008) who used up to eight. Again all
of pain in labour. Simpkin & O’Hara (2002) amount of tissue that can be grasped or pinched. If you except for Mårtensson et al.(2008) used the lumbosacral
evaluated five non pharmacological methods can grasp about 2.5 cms of skin, the needle is inserted region. Therefore, the number of injections used and
including continuous labour support; touch at a 45 degree angle (Figure 2) using a 17 mm 25G the anatomical location may depend on the situation:
and massage; baths; movement and positioning; needle. You can then continue to pinch the skin fold where the woman feels the pain; where the woman is
and sterile water injections. They found that as you insert the needle quickly or you can stretch the labouring; the number of health professionals available;
although all methods reduced labour pain skin and then insert the needle. It is easier to penetrate and the midwives’ skills. If the woman is experiencing
temporarily, sterile water injections had the most and it is less painful when the skin is pulled tightly. In generalised pain over the lower sacral area then the
consistent results. Huntley, Thompson Coon & both situations release the skin before injecting the four injection technique may be the method of choice
Ernst (2004) found 12 RCTs which included sterile water slowly. It may however, be difficult to give however if the woman can localise her pain to one
acupuncture, hypnosis, massage, biofeedback, a subcutaneous injection to very thin women who particular spot then one injection may be appropriate.
respiratory autogenic training and sterile water have little connective tissue. If 5cms of skin is grasped
injections in their systematic review of CAM used however, then the needle is injected at a 90 degree angle Varney et al. (2004) stated that the injections are more
to treat labour pain. They concluded that only using a 25G needle with a length that is approximately effective if women identify their own points of pain.
those trials using sterile water injections provided half the length of the skin fold. Inject the sterile water This is supported by Mårtensson et al. (2008) and
significant evidence of effectiveness. A later review slowly while you continue to maintain a grasp of the Bahasadri et al. (2006) studies. However, if the location
by Anderson and Johnson (2005) examined skin fold as obese women have a layer of fat above is in the lower back, Varney et al. (2004) suggest that
CAM used in health promotion and for obstetric the subcutaneous layer. (Crisp & Taylor, 2005). An the woman leans forward while standing, kneeling
treatments during the prenatal, intrapartum and intradermal injection is typically used for vaccine or or sitting during the procedure. This permits the
postpartum periods. In the intrapartum period serum screening (ibid) or to apply a local anaesthetic sacral dimples to be observed more easily if the four
they identified four interventions used to treat the (Johnson & Taylor, 2006). Fluid is injected under the injections technique is to be used. Peart et al. (2006)
pain of labour: acupuncture; massage; acupressure dermis at a 5 - 15 degree angle (as shown in Figure 2) noted that having an assistant to help administer the
and sterile water injections. These authors also so that a blister, papule or bleb is formed (Figure 3). injections simultaneously decreased the pain sensation
found that the only intervention that was effective During the procedure the skin should be stretched and experienced by the women. Women are also more
was sterile water injections. a 25 G needle inserted into the skin until resistance is willing to have the procedure repeated in another
felt. The needle is then advanced for about 3mm so labour if simultaneous injections are given (Mårtensson
Considerations for Practice the bevel of the needle is still visible under the skin. & Wallin, 1999).
The literature raises some interesting issues that require Further resistance should be felt as the sterile water
consideration. The following section discusses these in is injected slowly. A blister should be visible however Varney et al also suggest (using the one subcutaneous
relationship to midwifery practice within the context of if it does not form, it means the injection has been injection technique) that once the woman has
New Zealand and includes points related to performing placed lower into the subcutaneous tissue. Also, if no identified the area that is painful with her finger,
the techniques; guidance and informed consent. resistance is felt the fluid is probably being injected into that it is marked by the midwife or an assistant
the lower subcutaneous level (Crisp & Taylor, 2005). (Figure 4). Marking a circle around the woman’s
a) Techniques As pain relief is achieved by both routes this is probably finger allows the injection to be placed correctly. It
Firstly, the technique for inserting subcutaneous not so important for midwifery. This is supported by also permits the midwife to monitor the position
injections is easier than intradermal (intracutaneous) Mårtensson & Wallin (1999) who found that 89% of for further injections if pain returns although one
injections and has fewer problems. Figure 2 provides a women having had intracutaneous injections in their author noted that it is not necessary to be exact in the
diagram of the layers of the skin and the angles used of study would be willing to use the technique again placement of the injection site (Reynolds, 1998). The
each type of injection. compared to 81% in the subcutaneous group. subcutaneous injection can then be inserted (Figure 5).
Subcutaneous injections are inserted into the The second consideration around the technique is the With the exception of Peart et al. (2006), all researchers
connective tissue under the dermal layer of the number of injections and the anatomical location. All used 0.1 ml of sterile water when the route was
pain relief prior to transfer from a rural area or for Anderson, F. W. J., & Johnson, C. T. (2005). Complementary
b) Guidance and alternative medicine in obstetrics. International Journal of
women waiting for an epidural. It may also be an Gynecology & Obstetrics, 91(2), 116-124.
This is a technique that is not well known. For example, option for women who do not want to use narcotics Bahasadri, S., Ahmadi-Abhari, S., Dehghani-Nik, M., & Habibi, G.
although it has been identified as being used since 1990 or to have an epidural. R. (2006). Subcutaneous sterile water injection for labour pain: A
in the USA, a survey of 107 midwives knowledge and randomised controlled trial. Australian & New Zealand Journal of
Obstetrics & Gynaecology, 46(2), 102-106.
attitudes in that country (Mårtensson, McSwiggin, & c) Consent
Belville, R., & Seupaul, R. (2005). Pain measurement in pediatric
Mercer, 2008) found that 32% of the midwives used the Sterile water injections are another option for women Emergency Care: A review of the Faces Pain Scale-revised.
technique while 46% of midwives had no knowledge to consider particular if they are keen to use only Pediatric Emergency Care, 21(2), 90-93.
of it. From personal discussions with a number of non pharmacological methods of working with pain. Cheng, Y. W., Shaffer, B. L., & Caughey, A. B. (2006). Associated
factors and outcomes of persistent occiput posterior position:
midwives across the North Island not one identified Women should be offered concise information about A retrospective cohort study from 1976 to 2001. Journal of
that they had heard of the technique. Furthermore, a this technique during their pregnancy once midwives Maternal-Fetal & Neonatal Medicine, 19(9), 563-568.
personal enquiry to four of the education institutions are competent to offer it. The information should Coates, T. (2003). Malpositions of the occiput and malpresentations.
In D. M. Frazer & M. A. Cooper (Eds.), Myles textbook for
offering Bachelor of Midwifery programmes found include advantages and disadvantages of using the midwives (14 ed., pp. 551-579). Edinburgh: Churchill Livingston.
that none included the technique as a midwifery skill techniques; an explanation of the different techniques; Crisp, J., & Taylor, C. (Eds.). (2005). Potter& Perry’s fundamentals of
and in addition did not include intradermal injections when the method may be used; and a scientific nursing (2nd ed.). Sydney: Elsevier.
in their curriculum. Therefore, midwives from these explanation of how the technique works. Enkin, M., Keirse, M. J. N. C., Neilson, J., Crowther, C., Duley,
L., Hodnett, E., (2000). A guide to effective care in pregnancy and
programmes, as well as other midwives, may need childbirth. Oxford: Oxford University Press.
additional education and theoretical practise in the The advantages of this method of pain relief is that it is Freeman, K., Smyth, C., Dallam, L., & Jackson, B. (2001). Pain
technique in order to gain competence. relatively quick to administer in any situation, is cheap measurement scales: A comparison of the visual analogue and
faces rating scales in measuring pressure ulcer pain. Journal of
and can be used in homebirths, birthing units or major Wound, Ostomy & Continence Nursing, 28(6), 290-296.
A number of authors have provided advice regarding hospitals. It may be used as a main pain relief measure Harris, P., Nagy, S., & Vardaxis, N. (Eds.). (2006) (Australian &
undertaking the different techniques. For example, or used as an interim measure if the woman is being New Zealand Edition ed.). Sydney: Mosby Elsevier.
Health Canada. (2000). National Guidelines for Family-Centred
when withdrawing the needle after insertion of an transferred to secondary care for an epidural. Therefore Maternity and Newborn Care. Retrieved 24th April 2007, 2007,
intradermal injection do not massage the site with a swab it may be idea tool for midwives working in rural areas from http://www.phac-aspc.gc.ca/dca-dea/publications/fcmc05_e.html
Trolle, B., Moller, M., Kronborg, H., & Thomsen, S. (1991). The
effect of sterile water blocks on low back labor pain. American
Journal of Obstetrics & Gynecology, 164(5 Pt 1), 1277-1281
Ware, L. J., Epps, C. D., Herr, K., & Packard, A. (2006). Evaluation
of the revised Faces Pain Scale, Verbal Descriptor Scale, Numeric
Rating Scale, and Iowa Pain Thermometer in older minority
adults. Pain Management Nursing, 7(3), 117-125.