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.
| Holtzclaw, B J (1990) Control of febrile shivering during amphotericin B therapy. Oncol Nurs Forum 17:521-4 |
