Position and Mobilisation Post-Angiography Study (PAMPAS): a comparison of 4.5 hours and 2.5 hours bed rest

Effects of position change on lumbar pain and discomfort of Korean patients after invasive percutaneous coronary intervention: a RCT study

[Purpose] This study sought to examine the effects of position change on lumbar pain and discomfort of Korean patients after invasive percutaneous coronary intervention. [Subjects and Methods] The participants consisted of 48 patients (experimental: n=24, control: n=24) who underwent invasive coronary intervention (Percutaneous Coronary Intervention) in K hospital, Seoul, Korea. A randomized controlled trial design was used. Position changes as the experimental treatment were sequenced as follows: supine position for one hour after removal of the catheter; 30-degree bed-elevated lateral position for one hour; 30-degree bed elevation for one hour; and finally 30-degree bed-elevated lateral position for one hour. The thirty degree bed-elevated lateral position was intended to press on the surgical site. Measures used were the general characteristics form, Visual Analogue Scale for lumbar pain, and discomfort scale. [Results] There were significant differences on lumbar pain and discomfort of Korean patients after invasive coronary intervention between the experimental and control groups. [Conclusion] Position change was an effective intervention for decreasing lumbar pain and discomfort of Korean patients after invasive coronary intervention. Health professionals need to consider an array of methods including position change for patients after invasive coronary intervention.

The Effect of Head of Bed Elevation on Patient Comfort After Angiography

BACKGROUND

Maintaining patient comfort and avoiding complications after coronary angiography are important both to the patient and the nurse. Strict bed rest with the head of bed (HOB) completely flat is standard care for postprocedure positioning to decrease pressure on the femoral artery. This position is not thought to be the most comfortable position for patients.

OBJECTIVE

The purpose of this study was to determine if raising the HOB to 15° would impact patient comfort after cardiac angiography.

METHODS

This study used a randomized, controlled crossover design to compare 3 groups with different HOB positions during the first hour after procedure.

RESULTS

Data from 71 patients demonstrated that HOB position did not significantly impact difference in pain/discomfort rating.

CONCLUSIONS

Of all the nursing interventions designed to improve patient comfort after angiography, slightly raising the HOB was not a factor in reducing pain/discomfort.

Very Low Complication Rates with a Manual, Nurse-Led Protocol for Femoral Sheath Removal Following Coronary Angiography

OBJECTIVE

We aimed to provide contemporary information on the complication rates after femoral artery sheath removal using a specific, nurse-led protocol, which is universally applicable and can be readily adopted by other units.

BACKGROUND

Previous studies have reported a wide range of complication rates following femoral sheath removal after cardiac catheterisation. A variety of methods has been used for access site management and therefore it is difficult to compare complication rates between units.

METHOD

Data were collected prospectively on patients undergoing diagnostic coronary angiography via the transfemoral route in a single centre. Sheaths were removed by trained cardiac nurses with direct application of manual pressure over the femoral artery in accordance with a specific protocol. We also investigated the same endpoints in patients who received an arteriotomy closure device (ACD) during the study period.

RESULTS

None of the 516 patients who had their femoral sheaths removed with manual compression developed a major haematoma or complication. A minor haematoma developed in 1.6% of patients. Similarly, none of the 484 patients who received an ACD developed a major haematoma and 0.8% developed a minor haematoma. Mean arterial blood pressures were higher in patients that developed a haematoma.

CONCLUSION

Our study shows that a manual, nurse-led system of femoral sheath removal following diagnostic coronary angiography is very safe and effective and that this remains a viable method of access site management.

Feasibility and safety of transfemoral intra-arterial chemotherapy for head and neck cancer using a 3-French catheter system: comparison with a 4-French catheter system

PURPOSE

To assess the technical feasibility of transfemoral intra-arterial chemotherapy for head and neck cancer using a 3-French catheter system (3-Fr).

MATERIALS AND METHODS

Sixty-two patients with head and neck cancer who underwent transfemoral intra-arterial chemotherapy were included in this study. Thirty-three patients underwent treatment using a 3-Fr (group 3-Fr). Twenty-nine patients underwent treatment using a 4-French catheter system (group 4-Fr). The technical success rate, duration of the procedure with fluoroscopy, and rate of procedure-related complications were compared between group 3-Fr and group 4-Fr. In addition, in group 3-Fr, bleeding at the puncture site after 1.5 h of bed rest was evaluated.

RESULTS

The technical success rate was 100% in both groups. The duration of the procedure with fluoroscopy didn't differ between group 3-Fr (mean 28.0 min) and group 4-Fr (mean 30.2 min) (p = 0.524). There was no procedure-related complication in either group. In group 3-Fr, no hemorrhagic complication was observed.

CONCLUSION

A 3-French catheter system can be used to perform transfemoral intra-arterial chemotherapy for head and neck cancer and is technically feasible with approximately the same duration of the procedure with fluoroscopy. Furthermore, this method may shorten the bed rest time without hemorrhagic complication, and may reduce the risk of pulmonary embolism.

Effect of Positioning and Early Ambulation on Coronary Angiography Complications: a Randomized Clinical Trial

INTRODUCTION

After coronary angiography to prevent potential complications, patients are restricted to 4-24 hours bed rest in the supine position due to the complications. This study was designed to assess the effect of changing position and early ambulation on low back pain, urinary retention, bleeding and hematoma after cardiac catheterization.

METHODS

In this clinical trial, 140 patients by using a convenience sampling randomly divided into four 35-individual groups. The patients in the control group were in the supine position for 6 hours without a movement. Change position was applied to the second group (based on a specific protocol), early ambulation was applied to the third group and both early ambulation and change position were applied to the fourth group. Then, severity of bleeding, hematoma, back pain and urinary retention were measured at zero, 1, 2, 4, 6, and 24 hours after angiography. The data was collected through an individual data questionnaire, Numerical Rating Scale (NRS) of pain and Kristin Swain's check list was applied to evaluate the severity of bleeding and hematoma.

RESULTS

None of patients developed vascular complications. Incidence of urinary retention was higher in the control group, although this difference was not significant. The mean of pain intensity in the fourth and sixth hours showed a significant difference.

CONCLUSION

Based on the findings of this study, changing patients' position can be safe and they can be ambulated early after angiography.

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.

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.

Four hour ambulation after angioplasty is a safe practice method

BACKGROUND

During the last 3 decades, there were increasing tendency towards angioplasty because of its benefits. But, this procedure has its acute problems like bleeding and formation of hematoma in the removal place of the sheet. Based on researchers' clinical experiences, patients need a time of 8-12 hours for bed rest after coronary angioplasty. Recognizing desirable time for bed rest after angioplasty and remove the arterial sheet forms the foundation of related researches in the world. Getting out of bed soon after angioplasty, causes more comfortable feelings, less hospitalization period, fewer side effects of prolonged bed rest and less hospitalization expenses. Regarding less time for bed rest after angioplasty, the aim of this study was to assess the effect of the time of getting out of bed after angioplasty on the complications after removing the sheet in coronary angioplasty patients.

METHODS

This was an experimental clinical study conducted in one step and two groups. Samples were included 124 angioplasty patients (62 in each group) who were chosen randomly from the CCU of Shahid Chamran hospital of the Isfahan University of Medical Sciences in 2007. Data were gathered by observing and evaluating the patients, using a questionnaire and a checklist. After angioplasty, patients from the intervention group were taken out of bed in 4 hours and patients from the control group were taken out of bed in 8 hours. After taking out of bed, patients were examined for bleeding and formation of hematoma in the place of taking out the arterial sheet. Data were analyzed using descriptive and inferential statistics via SPSS software.

RESULTS

Results showed no meaningful difference between the two groups after getting out of bed (p > 0.05) regarding relative frequency of bleeding (p = 0.50), formation of hematoma (p = 0.34) and average diameter of hematoma (p = 0.39).

CONCLUSIONS

Results of this study showed that reducing the bed rest time to 4 hours after removing the arterial sheet of size 7 do not increase bleeding and formation of hematoma in the removal place of the sheet. So, those angioplasty patients who do not have critical clinical condition and their vital symptoms are stabilized will be able to get out of bed 4 hours after removing the sheet.

Reduction of bed rest time after transfemoral noncardiac angiography from 4 hours to 2 hours: a randomized trial and a one-arm study

PURPOSE

To evaluate the feasibility of shortening the bed rest time from 4 hours to 2 hours after transfemoral noncardiac angiography with a 4-F sheath (outer diameter, 1.93 mm), a 5-F sheath (outer diameter, 2.27 mm), and a 4-F catheter.

MATERIALS AND METHODS

Patients were randomized into two groups, receiving either 2 or 4 hours of bed rest after hemostasis by manual compression of the puncture site. The authors evaluated the frequency of bleeding complications. An interim analysis was performed wherein 40 patients were assigned to each group. After the analysis, a single-arm 2-hour bed rest trial was conducted in an additional 115 procedures.

RESULTS

In the interim analysis, three of the 40 patients in the 4-hour group and none of the 40 patients in the 2-hour group developed minor bleeding within 2 hours after manual compression (P = .24). After 2 hours of bed rest, no bleeding complication was observed in either group. In the single-arm 2-hour bed rest trial, minor bleeding developed in one of the 115 procedures (0.8%). Through the study, minor bleeding occurred in four of the 195 total procedures (2%), and no major complications developed. The occurrence of a bleeding complication was significantly higher in patients with platelet counts of less than 100 x 10(9)/L than in the other patients (4/67 vs 0/128, P = .01).

CONCLUSIONS

Two hours of bed rest is feasible for patients undergoing transfemoral noncardiac angiography by using a 4-5-F sheath and/or a 4-F catheter, especially those with a normal platelet count.

The effect of changing position and early ambulation after cardiac catheterization on patients' outcomes: a single-blind randomized controlled trial

BACKGROUND

Cardiac catheterization is the gold standard diagnostic test for coronary heart diseases. In order to minimize the post-procedure complications, patients are restricted to prolonged bed rest that is always accompanied by fatigue and discomfort.

OBJECTIVE

The aim of this study was to assess the effect of changing position and early ambulation on the level of comfort, satisfaction, and fatigue and on the amount of bleeding and hematoma after cardiac catheterization.

PARTICIPANTS

A sample of 70 patients, who had undergone a non-emergency 6-French cardiac catheterization via the femoral artery from September to November, 2006.

METHODS

In a single-blind randomized controlled trial, each patient was randomly assigned to either the control or experimental group. The patients' position in the experimental group was intermittently changed during the first 6h after catheterization. Seven hours after the procedure, they were allowed to be ambulated and to undertake their self care activities. A pillow was placed under the patients' bodies. Patients in the control group were managed as routine; they were restricted to a 10-24h bed rest bed rest in supine position with the affected leg straight and immobilized and a sand bag on the puncture site for at least 8h. The levels of comfort, satisfaction and fatigue, and the amount of bleeding and hematoma were measured at regular intervals after the procedure.

RESULTS

The patients in the experimental group had significantly higher comfort and satisfaction and lower fatigue levels than the control group at 3, 6, 8h and the next morning after catheterization (P<0.01). Changing patients' position according to the current protocol in the experimental group produced no significant increase in the amount of bleeding and hematoma when compared with the control group (P>0.05).

CONCLUSION

The results of this study showed that the levels of comfort, satisfaction and fatigue after catheterization are related to the duration of bed rest and patients' position in bed. Changing patients' position accompanied by early ambulation after cardiac catheterization are associated with increasing comfort and satisfaction levels and decreasing the level of fatigue without increasing the amount of bleeding and hematoma.

The clinical effectiveness of length of bed rest for patients recovering from trans-femoral diagnostic cardiac catheterisation

BACKGROUND

Cardiac catheterisation plays a vital role in the diagnosis and evaluation of cardiac conditions. The goal of management of patients after cardiac catheterisation is to reduce the risk of development of any local or prolonged vascular complications, in particular bleeding and haematoma formation at the puncture site. Bed rest and immobilisation of the affected leg are recommended practices to ensure adequate haemostasis at the femoral arterial puncture site and prevent complications.

OBJECTIVES

The objective of this review was to present the best available evidence for the optimal length of bed rest after trans-femoral diagnostic cardiac catheterisation. The main outcome of interest was the incidence of bleeding and haematoma formation following varying periods of bed rest.

SEARCH STRATEGY

We searched the following databases: CINAHL, Medline, Cochrane Library, Current Contents, EBSCO, Web of Science, Embase, British Nursing Index, Controlled clinical trials database, Google Scholar. Reference lists of relevant articles and conference proceedings were searched. We also contacted key organisations and researchers in the field.

SELECTION CRITERIA

All randomised and quasi-randomised controlled trials that compared the effects of different lengths of bed rest following trans-femoral diagnostic cardiac catheterisation on patient outcomes were considered for inclusion in the review.

DATA COLLECTION AND ANALYSIS

Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials were assessed independently by two reviewers. Odds ratios (OR) for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, trials were considered separately.

MAIN RESULTS

Eighteen trials involving a total of 4294 participants were included in the review. One trial included three treatment groups. In seven trials among 747 people there was no significant difference in the incidence of bleeding following six or less than 6 h of bed rest (OR 1.47; 95% CI 0.60, 3.64). Likewise, there was no significant difference in the incidence of bleeding following bed rest at other time periods. In eight trials involving 2272 patients there was no significant difference in the incidence of haematoma formation following 6 or less than 6 h of bed rest (OR 0.82; 95% CI 0.59, 1.16). Significantly fewer patients randomised to less than 6 h of bed rest complained of back pain. The odds of developing back pain at 4 (OR 24.60; 95% CI 1.29, 469) and 24 h (OR 2.47; 95% CI 1.16, 5.23) following coronary catheterisation was significantly higher among patients randomised to 6 compared with 3 h of bed rest.

AUTHORS' CONCLUSIONS

There is evidence of no benefit relating to bleeding and haematoma formation in patients who have more than 3 h of bed rest following trans-femoral diagnostic cardiac catheterisation. However, there is evidence of benefit relating to decreased incidence and severity of back pain and cost-effectiveness following 3 h of bed rest. There is suggestive but inconclusive evidence of a benefit from bed rest for 2 h following trans-femoral cardiac catheterisation. Clinicians should consider a balance between avoiding increased risk of haematoma formation following 2-2.5 h of bed rest and circumventing back pain following more than 4 h of bed rest.

Barriers to mobility during hospitalization from the perspectives of older patients and their nurses and physicians

BACKGROUND

Low mobility is common during hospitalization and is associated with adverse outcomes. Understanding barriers to the maintenance or improvement of mobility is important to the development of successful interventions.

OBJECTIVES

To identify barriers to mobility during hospitalization from the perspectives of older patients and their primary nurses and physicians, to compare and contrast the perceived barriers among these groups, and to make a conceptual model.

DESIGN

Qualitative interviews analyzed and interpreted using a grounded theory approach.

SETTING

Medical wards of a university hospital.

PARTICIPANTS

Twenty-nine participants--10 patients >or= 75 years, 10 nurses, and 9 resident physicians.

MEASUREMENTS

Participants were interviewed using a semistructured interview guide, with similar questions for patients and health care providers. Interviews were audiotaped, transcribed, and reviewed for common themes by independent reviewers. Perceived barriers to mobility were identified, and their nature and frequency were examined for each respondent group.

RESULTS

Content analysis identified 31 perceived barriers to increased mobility during hospitalization. Barriers most frequently described by all 3 groups were: having symptoms (97%), especially weakness (59%), pain (55%), and fatigue (34%); having an intravenous line (69%) or urinary catheter (59%); and being concerned about falls (79%). Lack of staff to assist with out-of-bed activity was mentioned by patients (20%), nurses (70%), and physicians (67%). Unlike patients, health care providers attributed low mobility among hospitalized older adults to lack of patient motivation and lack of ambulatory devices.

CONCLUSIONS

Recognizing and understanding perceived barriers to mobility during hospitalization of older patients is an important first step toward developing successful interventions to minimize low mobility.

Bed-rest post-femoral arterial sheath removal - What is safe practice? A clinical audit

Numbers of patients undergoing coronary angiography and angioplasty procedures have increased in England due to targets within the National Service Framework for Coronary Heart Disease. Little evidence is available regarding optimal bed-rest duration for patients post-femoral arterial sheath removal following these procedures. Through literature review and clinical benchmarking, we aimed to identify what best practice was in the UK and whether bed rest times at our centre could be reduced without increasing complications to enable increased day case procedures. An audit tool was designed to collect data regarding method of obtaining haemostasis, length of bed-rest post-sheath removal and any post-procedural complications experienced by the patient. From a convenience sample of consecutive patients, 195 complete sets of baseline data revealed an average (median) period of 6-h bed rest. This was reduced to 3h and audit repeated yielding 176 complete data sets using the same audit tool. Femoral wound site complication rates were not significantly affected by reducing bed-rest time for diagnostic or interventional procedures. These findings contributed to an important change in practice, reducing length of stay post-procedure and should be re-explored due to increased use of femoral arterial closure devices.