Early sheath removal and ambulation in patients submitted to percutaneous coronary intervention: A randomised clinical trial

Implementation of the UMove Mobility Program to Promote Safe Patient Mobility and Reduce Falls in the Hospital Setting

The purpose of the current quality improvement (QI) project was to implement the UMove Early Mobility Program to engage patients in safe out of bed (OOB) activities and reduce falls, specifically focusing on toileting-related falls, during the hospital stay. Eight nursing units implemented the UMove program, including the UMove Mobility Screen (UMove MS), to select strategies to reduce toileting-related falls while increasing mobility. De-identified, unit-based data were collected from hospital reports. Nursing had a 95% documentation compliance rate for the UMove MS, and OOB activities and ambulation were documented at 50% and 57%, respectively. There was no statistical difference found in reducing toileting-related falls or sustaining increased OOB activities across the 15-month QI project. Toileting-related falls approached significance with a rate reduction from 1.77 pre-implementation to 0.23 at 6 months and no toileting-related falls at 12 months. Despite no significant findings, there is evidence that clinical changes occurred with nurses assessing and promoting mobility, while implementing strategies to reduce toileting-related falls. [Research in Gerontological Nursing, 17(1), 19-29.].

Factors Associated With Function-Focused Care Among Hospitalized Older Adults With Dementia

BACKGROUND

Function-focused care is an approach used to increase physical activity in hospitalized older adults with dementia.

OBJECTIVE

To explore factors associated with participation in function-focused care in this patient population.

METHODS

This was a cross-sectional descriptive study using baseline data from the first 294 participants in an ongoing study on testing function-focused care for acute care using the evidence integration triangle. Structural equation modeling was used for model testing.

RESULTS

The mean (SD) age of the study participants was 83.2 (8.0) years, and the majority were women (64%) and White (69%). Sixteen of the 29 hypothesized paths were significant and explained 25% of the variance in participation in function-focused care. Cognition, quality of care interactions, behavioral and psychological symptoms associated with dementia, physical resilience, comorbidities, tethers, and pain were all indirectly associated with function-focused care through function and/or pain. Tethers, function, and quality of care interactions were all directly associated with function-focused care. The χ2/df was 47.7/7, the normed fit index was 0.88, and the root mean square error of approximation was 0.14.

CONCLUSION

For hospitalized patients with dementia, the focus of care should be on treating pain and behavioral symptoms, reducing the use of tethers, and improving the quality of care interactions in order to optimize physical resilience, function, and participation in function-focused care.

Effects of Valsalva Maneuver on Pain and Vasovagal Reaction During the Removing of Femoral Arterial Sheath After Percutaneous Coronary Intervention: A Randomized Controlled Trial

PURPOSE

The objective of this study was to investigate the effects of the Valsalva maneuver on pain and vasovagal reactions during femoral arterial sheath removal in patients undergoing percutaneous coronary intervention.

DESIGN

This study was a randomized controlled trial.

METHODS

In this study, 60 patients undergoing elective coronary angioplasty were randomly assigned to the intervention and control groups. After angioplasty, the patients in the intervention group performed the Valsalva maneuver (20-30 mm Hg) for 10 seconds during the sheath removal. Conversely, in the control group, no inspiratory pressure was applied. Before and immediately after the sheath removal, the patients' pain, vital signs, and vasovagal reactions were measured.

FINDINGS

The primary characteristics of the patients were similar in the two groups. The patients in the intervention group had significantly lower pain scores during femoral sheath removal compared to the control group (2.33 ± 1.56 vs 5.56 ± 3.08, P < .001). The Valsalva maneuver during femoral sheath removal decreased the patients' heart rate in the intervention group compared to the control group (78.26 ± 12.37 vs 85.46 ± 11.79, P < .001); however, blood pressure and vasovagal reactions were not significantly different.

CONCLUSIONS

This study showed that the Valsalva maneuver during femoral arterial sheath removal can reduce the pain severity score, without increasing the incidence of vasovagal reactions.

Promoting Early Mobility in Patients After Transcatheter Aortic Valve Replacement: An Evidence-Based Protocol

BACKGROUND

Aortic stenosis is prevalent among older adults and is commonly treated with transcatheter aortic valve replacement. Both high- and low-risk patients benefit from early mobility and discharge after this procedure; however, hospital protocols to improve patient mobility and shorten hospital stays have not been systematically implemented.

OBJECTIVE

To develop and evaluate a post-transcatheter aortic valve replacement protocol to standardize care and efficiently advance patients from the operating room to discharge.

METHODS

A prospective pre-post design was used to evaluate the effect of the new standardized protocol on length of stay, timing of mobility, time spent in intensive care, and quality of life in patients undergoing transcatheter aortic valve replacement between April 2019 and March 2020.

INTERVENTIONS

Interventions included team-based education and integration of an evidence-based order set into the electronic health record. Education was provided to both patients and staff.

RESULTS

At 6 months after implementation of the intervention, statistically significant improvements were observed in mean overall (5.26 vs 2.45 days; P = .001) and postprocedure (3.05 vs 2.16 days; P = .004) length of stay. No significant difference was found in performance on the 5-meter walk test. Quality of life improved in both groups from baseline to 30-day follow-up (P = .01).

CONCLUSION

Implementation of the post-transcatheter aortic valve replacement protocol was associated with significant improvement in overall and postprocedure length of stay and improved quality of life. Additional work is needed to examine strategies to ensure safe next-day discharge.

Effects of early mobilization protocol performed after cardiac surgery on patient care outcomes

AIM

This study aimed to determine the effects of an early mobilization protocol performed in patients who underwent cardiac surgery on post-operative outcomes.

BACKGROUND

Post-operative complications are common in patients undergoing cardiac surgery. Early mobilization is recommended for patients who undergo cardiac surgery to prevent complications and achieve successful outcomes in post-operative care.

DESIGN

The study design was quasi-experimental with a control group.

METHODS

Participants were patients who underwent cardiac surgery between January and October 2015. The study included 102 patients (51 patients each in the experimental and control groups). The introductory characteristics form, the Richards-Campbell Sleep Questionnaire (RCSQ), duration of hospital stay (post-operatively), and development of a post-operative late complications form were used to collect data.

RESULTS

The study results revealed that patients in the experimental group had better improvement in RCSQ scores, shorter duration of hospitalization, and fewer late complications after surgery than patients in the control group.

CONCLUSION

Early mobilization is feasible in adult cardiac surgery patients and has significant benefits. More research is recommended into the effectiveness of early mobilization in different patient groups.

The effect of the application of cold on hematoma, ecchymosis, and pain at the catheter site in patients undergoing percutaneous coronary intervention

Objective

This study was conducted to determine the effect of the application of cold on hematoma, ecchymosis, and pain in patients undergoing percutaneous coronary intervention.

Methods

It is a quasi-experimental study with a control group. A total of 200 patients (100 in the control group and 100 in the experimental group) were included in the research. In the experimental group, a cold pack was applied to the bottom of the sandbag for the first 15 min after withdrawing the femoral arterial catheter. Both groups were assessed and followed up at the first 15th minute and 4th, 48th and 72 nd h.

Results

After the femoral arterial catheter was withdrawn, ecchymosis and hematoma were smaller and pain was less in the experimental group at the catheter entry site compared to the control group, and the difference was statistically significant (P < 0.01).

Conclusion

It was determined that the application of cold reduced the formation of hematomas, ecchymoses and pain in patients after the withdrawal of the femoral arterial catheter.

The effect of evidence-based care guidelines on outcomes after removal of arterial sheath in patients undergoing angioplasty

BACKGROUND

Evidence-based clinical care guidelines effectively assists medical teams to increase the quality of clinical practice, and improve outcomes in patients. This study aimed to design and implement evidence-based care guidelines for removing arterial sheath in patients undergoing angioplasty of coronary artery.

METHODS

This clinical trial study was performed on 200 patients (two groups of 100 patients) with mean age of 62.5 ± 10.8 years, from July 2014 to February 2014 in Baqiyatallah University of Medical Sciences (BUMS), Tehran, Iran. First, we designed a five-step guideline for removing arterial sheath. Then, the designed guideline (based on five-step Stetler model, i.e. preparation, validation, comparative study, implementation, and execution) in the current study, and the routine guideline were used for removing arterial sheath in patients in the intervention and the control groups, respectively. In both groups, the relevant outcomes including bleeding, vasovagal reactions, urinary retention, and pain were evaluated.

RESULTS

There were significant differences between the two groups in terms of bleeding, hematoma, vasovagal reactions (n = 11 versus n = 24), urinary retention (n = 8 versus n = 31), and back pain after removing arterial sheath (P < 0.050 for all).

CONCLUSION

Based on the results of this study, the use of evidence-based care guidelines after removal of atrial sheath in patients undergoing angioplasty is recommended.

Optimizing Function and Physical Activity in Hospitalized Older Adults to Prevent Functional Decline and Falls

Physical activity, defined as bodily movement that expends energy including such things as bed mobility, transfers, bathing, dressing, and walking, has a positive impact on physical and psychosocial outcomes among older adults during their hospitalization and the post hospitalization recovery period. Despite benefits, physical activity is not the focus of care in the acute care setting. Further there are many barriers to engaging patients in physical activity and fall prevention activities including patient, family and provider beliefs, environmental challenges and limitations, hospital policies, and medical and nursing interventions. This paper provides an overview of falls and physical activity prevalence among acute care patients, challenges to engaging patients in physical activity and falls prevention activities and innovative approaches to increase physical activity and prevent falls among older hospitalized patients.

Safety and efficacy of using vascular closure devices for hemostasis on sheath removal after a transfemoral artery percutaneous coronary intervention

AIM

To determine the efficacy of vascular closure devices (VCDs) for hemostasis following transfemoral percutaneous coronary interventions (PCIs).

METHODS

This two-group pre-post-test observational study with purposive sampling enrolled 73 patients between January, 2014 and February, 2015. The patients were allocated to either the intervention (vascular closure devices group, n = 34) or the control group (manual compression [MC] group, n = 39). Questionnaires were used to assess their demographic and clinical characteristics, vascular complications, visual analogue scale score for pain, and discomfort levels. Pain and discomfort were measured before and after the PCI.

RESULTS

Vascular complications were observed in 15 (44.1%) VCD patients and 13 (33.3%) MC patients, with no significant between-group difference. However, the VCD patients had a higher relative risk of bruising, hematomas, and need for further treatment. After the PCI, the pain scores and discomfort levels increased significantly in both groups, but the VCD patients had more successful hemostasis, less pain, and less physical and psychological discomfort (lower-limb numbness, shoulder pain, restlessness, and worrying about walking ability, being unable to lift heavy objects in the future, and taking time off from work).

CONCLUSION

The VCDs seem to be superior to the MCs, providing more successful hemostasis, less pain and discomfort, and earlier ambulation after a transfemoral PCI. These findings aid clinical nurses in understanding the risk of vascular complications, discomfort, and pain that are associated with VCD use for improving the quality of clinical care and help clinicians in determining the appropriate hemostatic method for patients undergoing a transfemoral PCI, particularly in the Chinese population.

Feasibility and Efficacy of Function-Focused Care for Orthopedic Trauma Patients

To overcome challenges associated with optimizing function and physical activity among hospitalized older adults, we developed function-focused care for acute care (FFC-AC). The purpose of this study was to test the feasibility and preliminary effectiveness of this intervention. We hypothesized that hospitalized trauma patients exposed to FFC-AC would (1) maintain or improve function, spend more time in physical activity, and have fewer adverse events between admission and discharge; and (2) maintain or improve function, have less fear of falling, fewer depressive symptoms, less pain, be more physically resilient, and be less likely to experience adverse events at 1 month postdischarge compared with those exposed to FFC-education only (EO). FFC-AC was implemented by a research function-focused care nurse who worked on the participating units for 20 hr a week for 16 months to implement the three components of FFC-AC. The sample included 89 older orthopedic trauma patients the majority of whom were female (N = 59, 66%), white (N = 82, 92%), and not married (N = 53, 59%). At discharge and/or 30 days postdischarge, participants in the treatment site showed greater improvement in function, less fear of falling, and better physical resilience when compared with those in the FFC-EO site. Future research is needed to continue to work on engaging staff in function-focused care approaches and optimizing the hospital environment and policies to support nurses in this type of care approach.

Evaluation of feasibility and safety of changing body position after transfemoral angiography: A randomized clinical trial

BACKGROUND

Considering the growing number of patients who suffer from cardiovascular and coronary artery disease and the significant importance of angiography in the diagnosis of coronary artery disease, this study investigated the effects of position change on the acute complications of coronary angiography.

METHODS

This study was a randomized clinical trial. Sixty patients undergoing coronary angiography, which was performed by a single operator were selected by convenience sampling method and were assigned to intervention or control groups by randomized block design (30 cases in each group). Intervention group patients' position was changed according to schedule, whereas patients in the control group remained in the supine position in complete bed rest. At the entrance hours, 3, 6, 8, and 24 hours after the angiography, patients in both groups were evaluated in terms of vascular complications, urinary retention, low back pain, groin pain, and comfort. Data were analyzed by repeated measures, Friedman, Mann-Whitney, chi-square, independent t-test, and Kolmogorov-Smirnov tests with SPSS-22.

RESULTS

The two groups did not show any significant difference in terms of demographic, clinical, and preinterventional catheterization characteristics (P > 0.05). There was no significant difference with regard to vascular complications including hematoma (P = 0.149), bleeding (P > 0.01), bruise (P = 0.081), and thrombosis in the two groups of patients during 5 consecutive reviews. However, there was a significant statistical difference regarding low back pain (P < 0.001), groin pain (P < 0.001), urinary retention (P = 0.02), and comfort (P < 0.001).

CONCLUSIONS

The results of this study showed that changing the positions of patients after angiography based on the provided program created no change in the incidence of vascular complications (hematoma, bleeding, thrombosis, and bruise) but resulted in reduced severity of back pain, groin pain, urinary retention, and increased patients' comfort.

Decreased bed rest post-percutaneous coronary intervention with a 7-French arterial sheath and its effects on vascular complications

AIMS AND OBJECTIVES

To compare the incidence of femoral access puncture site complications in the control group, who underwent 6 hr of bed rest, with patients in the case group, who underwent 4 hr of bed rest.

BACKGROUND

The ideal bed rest length after percutaneous coronary intervention with a 7-French arterial sheath has been investigated by nursing practice. However, in this larger-sheath-size group, best practices have not been determined, and bed rest time continues to vary markedly among institutions.

DESIGN

Retrospective study.

METHODS

Data were retrieved from the National Cardiovascular Data Registry and electronic health records in this retrospective study. Sample size was 401 patients: 152 case patients with 4-hr bed rest and 249 controls with 6-hr bed rest. Case group data were obtained from 20 May 2013-31 December 2014; and control group data, 15 June 2011-20 May 2013.

RESULTS

National Cardiovascular Data Registry event rates were generally low in both groups: Only three patients in each group had a bleeding event within 72 hr (2% vs. 1%) and no patient and only two controls had arteriovenous fistula (0% vs. 1%). Complications documented in the electronic health records with institutional femoral access puncture site complication definitions identified bleeding at the access site in eight case patients (5%) and nine controls (4%). Haematoma at the access site occurred in 21 case patients (14%) and 25 controls (10%).

CONCLUSIONS

The practice change of decreasing bed rest from 6-4 hr for patients with 7-French arterial sheaths post-percutaneous coronary intervention was associated with no significant change in femoral access puncture site complications in either National Cardiovascular Data Registry data or institutional electronic health records data.

RELEVANCE TO CLINICAL PRACTICE

This introduces expanded evidence of safety in decreasing bed rest length in larger (7-French) arterial sheaths post-percutaneous coronary intervention.

Access site complications following transfemoral coronary procedures: comparison between traditional compression and angioseal vascular closure devices for haemostasis

BACKGROUND

Vascular closure devices such as angioseal are used as alternatives to traditional compression haemostasis. Although the safety and efficacy of angioseal are confirmed, their use remains controversial because of the potential complications of these devices compared with those of traditional compression haemostasis. The aim of this study was to compare the access site complication rate, the predictive factors for these complications, and patient comfort levels after coronary procedures with traditional compression or angioseal haemostasis.

METHODS

Data were collected from a cardiac unit in a medical center in northern Taiwan. A total of 130 adult patients were recruited and equally divided into two groups according to the method of haemostasis used after the coronary procedure: a traditional compression group and an angioseal group. We observed the incidence of access site complications, including bleeding, oozing, haematoma formation, and arteriovenous fistula formation. In addition, we used a 0-10 numeric rating scale to assess soreness, numbness, and back and groin access site pain after 1 h of catheter removal and immediately before getting out of bed.

RESULTS

The overall incidence of complications was 3.8 % (n = 5), which was not significantly different between the two groups (p = .06). The propensity score--adjusted multivariate analyses revealed that the only independent predictor for access site complications was an age of >70 years (OR, 10.44; 95 % CI, 1.81-60.06; p = .009). Comfort levels were higher in the angioseal group than in the traditional compression group.

CONCLUSIONS

Angioseal used after coronary procedures did not increase the incidence of complications relative to that associated with traditional compression haemostasis; however, it increased patient comfort levels. Health personnel should pay special attention to the predictive factor for access site complications after coronary procedures, such as age >70 years.

Vascular complications of early (3 h) vs standard (6 h) ambulation post-cardiac catheterization or percutaneous coronary intervention from the femoral artery

BACKGROUND

The optimal time of ambulation post cardiac catheterization (CC) or percutaneous coronary intervention (PCI) done from the femoral artery is not well defined. The aim of this study was to determine whether early (3 hrs) ambulation post CC/PCI is as safe as standard (6 hrs) ambulation time.

METHODS

This was a retrospective observational study comparing the vascular complications rate (bleeding, hematoma, pseudoaneurysm formation) among patients who underwent CC, alone or concomitant with PCI, from the femoral artery and who were ambulated after 3 or 6 hrs.

RESULTS

The study population consisted of a total of 262 patients, 147 were ambulated after 3 hrs and 115 were ambulated after 6 hrs. There were no differences between the two groups with respect to age, gender, body mass index, prior history of cardiac events, as well as the indication for performing the current CC/PCI. The rate of vascular complications was similar between the two groups (2.7% vs 2.6%, p=0.97). All vascular complications were managed conservatively and non required surgical intervention.

CONCLUSION

In this retrospective observational study, both early (3 hrs) and standard (6 hrs) ambulation after CC/PCI from the femoral artery had a similar and low rate of vascular complications. Cardiac catheterization laboratories need to be encouraged to adopt an early ambulation policy post CC/PCI from the femoral artery to improve patient comfort and expedite patient discharge from the hospital.

Immediate mobilization after coronary angiography or percutaneous coronary intervention following hemostasis with the AngioSeal vascular closure device (the MOBS study)

BACKGROUND

In patients undergoing coronary angiography or percutaneous coronary intervention (PCI), the standard post procedure regime includes immobilization and bed rest despite the use of vascular closure devices.

AIM

In the Mobilization after Coronary Angiography or Percutaneous Coronary Intervention (MOBS) study we compared bleeding complications after cardiac catheterization with femoral artery access after mobilization immediately off the angiographic table or standard care with1 hour (MOBS I after a diagnostic angiogram) or 2 hours of bed rest before mobilization (MOBS II after PCI).

METHODS

Bleeding complications were defined as major (requiring surgery of the femoral artery, transfusion or increased hospital stay) and minor (hematoma <5 × 5 cm(2), oozing from the puncture site or minor bleeding that could be compressed manually).

RESULTS

In the MOBS I cohort (100 patients were mobilized immediately and 100 patients followed standard care) no major bleeding complications were seen. In the immediate mobilization group 2.0% experienced minor bleeding compared to 4.0% in the standard care group (p=0.41). In the MOBS II cohort after PCI (158 patients were mobilized immediately and 161 patients followed standard care), major bleeding complication rates did not differ significantly between the two groups: immediate mobilization group 26.6% vs. standard care group 28.0%, p=0.78. The majority of bleeding complications were due to oozing: immediate mobilization group 22.8% vs. standard care group 20.5%, p=0.62.

CONCLUSIONS

Immediate mobilization after a coronary angiogram or PCI with the femoral access site closed by the closure device AngioSeal was not associated with increased bleeding risk compared to standard care with bed rest.

Bed rest duration after sheath removal following percutaneous coronary interventions: a systematic review and meta-analysis

AIMS AND OBJECTIVES

To explore the effect of bed rest duration after sheath removal following percutaneous coronary interventions on the incidence of vascular complications, back pain and urinary problems.

BACKGROUND

According to the literature, the duration of bed rest after sheath removal following percutaneous coronary interventions ranges from 2-24 hours. Several studies have assessed the effect of duration of bed rest on vascular complications, but a clear final conclusion about the exact duration of bed rest has not been reached.

DESIGN

Systematic review and meta-analysis.

METHODS

Cochrane Library, MEDLINE, SCOPUS, CINAHL, IranMedex and IranDoc were searched. No language limitation was applied. RCTs that used two different periods for ambulation were included. Two reviewers separately assessed the quality of each included study and extracted the data. Dichotomous outcomes were recorded as odds ratio with 95% confidence interval.

RESULTS

Five studies involving 1115 participants were included in the review. Among them, two studies had three comparison groups. The studies considered a variety of periods as early and late ambulation, ranging from 2-10 hours. Totally, there were no statistically significant differences in the incidence of bleeding, pseudoaneurysm, arteriovenous fistula and urinary problems between early and late ambulation. There was a statistically significant reduction in the risk of haematoma formation at four to six hours of bed rest compared with eight hours of bed rest (odds ratio = 0·37, 95% CI: 0·15, 0·91). Back pain was reported in one study evaluating three hours of bed rest with an odds ratio of 0·45 (95% confidence interval: 0·28, 0·71) when compared with 10 hours of bed rest.

CONCLUSIONS

Early ambulation after percutaneous coronary interventions is safe and feasible; however, the results should be used with caution as the majority of included studies had methodological flaws.

RELEVANCE TO CLINICAL PRACTICE

The results of this study suggest that patients could be ambulated three to four hours after sheath removal following percutaneous coronary interventions and early ambulation dose does not increase the risk of vascular complications, but it moderates back pain occurrence.

Meta-analysis of complication as a risk factor for early ambulation after percutaneous coronary intervention

PURPOSE

This study systematically examined previous studies on the effect of early ambulation on vascular complications in subjects who had just undergone a percutaneous coronary intervention (PCI), and analyzed the effects of early ambulation on both hemorrhage and hematoma formation at the puncture site.

METHODS

Study data were analyzed using the R (version 2.13.1) program. Publication bias was verified via regression analysis, using the logarithm of the odds ratio (OR) and sample size, and a funnel plot using sample size. The risk ratio of the incidence of bleeding and hematoma formation at the puncture site, relative to early ambulation, was confirmed using ORs and the forest plot.

RESULTS

The PCI recipients' bed rest time had no significant effect on the risk ratio of hematoma formation (OR = 0.89; 95% CI = 0.68-1.17) nor the incidence of bleeding (OR = 1.14; 95% CI = 0.77-1.7) at the puncture site.

CONCLUSIONS

This retrospective study's findings show that early ambulation following PCI had no effect on the incidence of either hematoma formation nor bleeding at the puncture site; however, differences in demographic factors should be considered carefully, in order to avoid interpreting the results too broadly.