This experimental study tests a nursing intervention to reduce drug-induced shivering related to amphotericin B. Predictors and consequences of shivering will be sought from patient responses and physiological correlates.
Specific aims are to: 1) test the efficacy of extremity wraps to reduce shivering incidence, severity and duration; 2) determine if extremity wraps reduce amounts of narcotic required to treat shivering; 3) determine if changes in skin-to-core temperature gradients precede or predict shivering; 4) determine the relationship between shivering severity and increased cardiac effort; and 5) determine relationships between subjective thermal perceptions, actual body temperature, and onset and severity of shivering. Hospitalized adults (n = 300), randomly assigned to treatment or control group, will be studied during a prescribed amphotericin B infusion. A subsample (n = 60) will be studied during 3 days of therapy, using a crossover design with each patient alternating treatment and control conditions. Treatment is aimed at protecting the most dominant heat-loss receptors in the skin and involves wrapping arms and legs with 3 layers of terry-cloth toweling prior to giving drug. Study variables are: 1) shivering on a scale of increasing extent shown by electromyography; 2) amount of meperidine to relieve shivering; 3) mean skin and core temperatures and 4) rate pressure product, derived from heart rate and systolic blood pressure; and 5) Subjective thermal comfort measured by visual analog scale. Analyses include: chi- square tests of the incidence and level of shivering, t-tests of means for meperidine dose, duration of shivering, temperature, and rate pressure product. Analyses of repeated measurements from the crossover design will include chi-square and repeated measures analysis of variance to identify sequence or subject effects. If effective, the intervention provides a low cost, easily administered alternative to drugs for shivering suppression and the basis for developing interventions for shivering in other clinical situations.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
1R01NR001890-01
Application #
3391754
Study Section
Nursing Research Study Section (NURS)
Project Start
1988-07-01
Project End
1991-06-30
Budget Start
1988-07-01
Budget End
1989-06-30
Support Year
1
Fiscal Year
1988
Total Cost
Indirect Cost
Name
Vanderbilt University Medical Center
Department
Type
Schools of Nursing
DUNS #
004413456
City
Nashville
State
TN
Country
United States
Zip Code
37203
Holtzclaw, B J (1990) Control of febrile shivering during amphotericin B therapy. Oncol Nurs Forum 17:521-4