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Meucci F, Stolcova M, Caniato F, Sarraf M, Mattesini A, Di Mario C. The Essentials of Femoral Vascular Access and Closure. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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2
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Vendrik J, Vlastra W, van Mourik MS, Delewi R, Beijk MA, Lemkes J, Wykrzykowska JJ, de Winter RJ, Henriques JS, Piek JJ, Vis MM, Koch KT, Baan J. Early mobilisation after transfemoral transcatheter aortic valve implantation: results of the MobiTAVI trial. Neth Heart J 2020; 28:240-248. [PMID: 32112292 PMCID: PMC7190768 DOI: 10.1007/s12471-020-01374-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Immobilisation of patients after transfemoral transcatheter aortic valve implantation (TF-TAVI) is the standard of care, mostly to prevent vascular complications. However, immobilisation may increase post-operative complications such as delirium and infections. In this trial, we determine whether it is feasible and safe to implement early ambulation after TF-TAVI. Methods We prospectively included TF-TAVI patients from 2016 to 2018. Patients were assessed for eligibility using our strict safety protocol and were allocated (based on the time at which the procedure ended) to the EARLY or REGULAR group. Results A total of 150 patients (49%) were deemed eligible for early mobilisation, of which 73 were allocated to the EARLY group and 77 to the REGULAR group. The overall population had a mean age of 80 years, 48% were male with a Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score of 3.8 ± 1.8. Time to mobilisation was 4 h 49 min ± 31 min in the EARLY group versus 20 h 7 min ± 3 h 6 min in the REGULAR group (p < 0.0001). There were no differences regarding the primary endpoint. No major vascular complications occurred and a similar incidence of minor vascular complications was seen in both groups (4/73 [5.5%] vs 6/77 [7.8%], p = 0.570). The incidence of the combined secondary endpoint was lower in the EARLY group (p = 0.034), with a numerically lower incidence for all individual outcomes (delirium, infections, pain and unplanned urinary catheter use). Conclusion Early mobilisation (ambulation 4–6 h post-procedure) of TF-TAVI patients is feasible and safe. Early ambulation decreases the combined incidence of delirium, infections, pain and unplanned urinary catheter use, and its adoption into contemporary TAVI practice may therefore be beneficial. Electronic supplementary material The online version of this article (10.1007/s12471-020-01374-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Vendrik
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands.
| | - W Vlastra
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - M S van Mourik
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - R Delewi
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - M A Beijk
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - J Lemkes
- Heart Centre, Amsterdam University Medical Centres (location VUMC), Amsterdam, The Netherlands
| | - J J Wykrzykowska
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - R J de Winter
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - J S Henriques
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - J J Piek
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - M M Vis
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - K T Koch
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - J Baan
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
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Feldman T, Sarraf M. The Essentials of Femoral Vascular Access and Closure. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ted Feldman
- NorthShore University HealthSystem; Evanston IL USA
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Lundén MH, Bengtson A, Lundgren SM. Hours During and After Coronary Intervention and Angiography. Clin Nurs Res 2016; 15:274-89. [PMID: 17056770 DOI: 10.1177/1054773806291855] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to describe patients’ experience during and after coronary angiography and percutaneous coronary intervention. Data were collected by interviews with 14 patients. A qualitative content analysis approach was used. Four main categories were identified that describe patients’ experience of the hours during and following intervention: emotional thoughts, bodily sensations, nursing intervention of importance, and personal strategies. All patients made a comment on staff conduct and pointed out that even minor nursing actions may be of great importance. Patients were most positive toward the transradial approach. Even though the approach via arteria radialis will increase, many patients will still have their procedure done via arteria femoralis. In spite of all research and technical developments, the patients’ experience from intervention via arteria femoralis is pretty much the same as it was 1997.
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MESH Headings
- Adaptation, Psychological
- Aged
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/methods
- Angioplasty, Balloon, Coronary/nursing
- Angioplasty, Balloon, Coronary/psychology
- Anxiety/etiology
- Anxiety/psychology
- Attitude to Health
- Coronary Angiography/adverse effects
- Coronary Angiography/methods
- Coronary Angiography/nursing
- Coronary Angiography/psychology
- Female
- Health Services Needs and Demand
- Hospitals, University
- Humans
- Male
- Middle Aged
- Nurse's Role
- Nursing Methodology Research
- Pain, Postoperative/etiology
- Pain, Postoperative/psychology
- Patient Education as Topic
- Perioperative Care/methods
- Perioperative Care/nursing
- Perioperative Care/psychology
- Qualitative Research
- Quality Assurance, Health Care
- Surveys and Questionnaires
- Sweden
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Affiliation(s)
- Maud H Lundén
- Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
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Chair SY, Li KM, Wong SW. Factors that Affect Back Pain among Hong Kong Chinese Patients after Cardiac Catheterization. Eur J Cardiovasc Nurs 2016; 3:279-85. [PMID: 15572016 DOI: 10.1016/j.ejcnurse.2004.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2004] [Revised: 10/02/2004] [Accepted: 10/06/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cardiac catheterization (CC) is a widely used cardiac investigation procedure in Hong Kong. However, back pain is frequently reported following CC due the prolonged bed rest after the procedure. AIM The overall aim of this study was to examine factors associated with back pain among Hong Kong Chinese patients after femoral access for CC. METHODS A prospective study, nested within a randomized clinical trial (RCT), employing secondary analysis of an existing data set from 419 Chinese adults receiving nonemergency CC, were used. Following a review of literature, gender, age, history of back pain, type of dressing on the puncture site, length of bed rest duration, turning privilege during bed rest, catheter size used for CC, duration of the procedure, duration of hemostasis, and body weight were identified as potential factors affecting back pain level. Back pain was assessed at 6 h and the next morning after CC, using the Numeric Pain Intensity Scale (NPIS). Analysis was done using multivariate analysis of variance (MANOVA), after testing for normality of the distribution. RESULTS Turning privilege (p = 0.001), age (p = 0.04), and body weight (p = 0.006) were significantly related to level of back pain at 6 h and the next morning after CC. CONCLUSION Results of this study may help nurses have a better understanding about patients' physical needs and appropriate nursing interventions that can be planned to enhance patient comfort following CC.
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Affiliation(s)
- Sek Ying Chair
- The Nethersole School of Nursing, Esther Lee Building, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.
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Dariushnia SR, Gill AE, Martin LG, Saad WE, Baskin KM, Caplin DM, Kalva SP, Hogan MJ, Midia M, Siddiqi NH, Walker TG, Nikolic B. Quality Improvement Guidelines for Diagnostic Arteriography. J Vasc Interv Radiol 2014; 25:1873-81. [DOI: 10.1016/j.jvir.2014.07.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 07/18/2014] [Accepted: 07/18/2014] [Indexed: 11/28/2022] Open
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Kobrossi S, Tamim H, Dakik HA. Vascular complications of early (3 h) vs standard (6 h) ambulation post-cardiac catheterization or percutaneous coronary intervention from the femoral artery. Int J Cardiol 2014; 176:1067-9. [PMID: 25175522 DOI: 10.1016/j.ijcard.2014.07.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/26/2014] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Semaan Kobrossi
- Department of Internal Medicine, American University of Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Lebanon
| | - Habib A Dakik
- Department of Internal Medicine, American University of Beirut, Lebanon.
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Mohammady M, Atoof F, Sari AA, Zolfaghari M. Bed rest duration after sheath removal following percutaneous coronary interventions: a systematic review and meta-analysis. J Clin Nurs 2013; 23:1476-85. [PMID: 24028631 DOI: 10.1111/jocn.12313] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2013] [Indexed: 12/29/2022]
Abstract
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.
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Affiliation(s)
- Mina Mohammady
- Nursing and Midwifery Faculty, Tehran University of Medical Sciences, Tehran, Iran
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Butman S. Size does not matter. Catheter Cardiovasc Interv 2012; 80:634-5. [PMID: 22996927 DOI: 10.1002/ccd.24613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Tongsai S, Thamlikitkul V. The safety of early versus late ambulation in the management of patients after percutaneous coronary interventions: A meta-analysis. Int J Nurs Stud 2012; 49:1084-90. [DOI: 10.1016/j.ijnurstu.2012.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 03/24/2012] [Accepted: 03/30/2012] [Indexed: 12/29/2022]
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Feldman T, Yong G. The Essentials of Vascular Access and Closure. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Rolley JX, Salamonson Y, Wensley C, Dennison CR, Davidson PM. Nursing clinical practice guidelines to improve care for people undergoing percutaneous coronary interventions. Aust Crit Care 2011; 24:18-38. [DOI: 10.1016/j.aucc.2010.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 07/14/2010] [Accepted: 08/03/2010] [Indexed: 11/26/2022] Open
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Nursing care practices following a percutaneous coronary intervention: results of a survey of Australian and New Zealand cardiovascular nurses. J Cardiovasc Nurs 2010; 25:75-84. [PMID: 20134285 DOI: 10.1097/jcn.0b013e3181bb419d] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although there is high-level evidence to guide optimal medical care for percutaneous coronary interventions, there are less explicit guidelines to support nurses in providing care. AIM This study describes the practice standards and priorities of care of cardiovascular nurses in Australia and New Zealand. METHOD Item generation for the survey was informed by an integrative literature review and existing clinical guidelines. A 116-item Web-based survey was administered to cardiovascular nurses, via electronic mail lists of professional cardiovascular nursing organizations, using a secure online data collection system. RESULTS Data were collected from March 2008 to March 2009. A total of 148 respondents attempted the survey, with 110 (74.3%) completing all items. All respondents were registered nurses with an average of 12.3 (SD, 7.61) years of clinical experience in the cardiovascular setting. A range of practice patterns was evident in ambulation time after percutaneous coronary intervention, methods of sheath removal, pain relief, and patient positioning. Respondents consistently rated psychosocial care a lower priority than other tasks and also identified a knowledge deficit in this area. CONCLUSION This survey identified diversity of practice patterns and a range of educational needs. Increasing evidence to support evidence-based practice and guideline development is necessary to promote high-quality care and improved patient outcomes.
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Moeini M, Moradpour F, Babaei S, Rafieian M, Khosravi A. Four hour ambulation after angioplasty is a safe practice method. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2010; 15:109-14. [PMID: 21589772 PMCID: PMC3093164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2010] [Accepted: 07/07/2010] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Mahin Moeini
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran,Correspondence to: Mahin Moeini, MSc.
| | - Fatemeh Moradpour
- School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sima Babaei
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Rafieian
- Department of Operating Room Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Khosravi
- Assistant Professor of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Schiks IEJM, Schoonhoven L, Aengevaeren WRM, Nogarede-Hoekstra C, van Achterberg T, Verheugt FWA. Ambulation after femoral sheath removal in percutaneous coronary intervention: a prospective comparison of early vs. late ambulation. J Clin Nurs 2009; 18:1862-70. [DOI: 10.1111/j.1365-2702.2008.02587.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Comparison of Complications in Percutaneous Coronary Intervention Patients Mobilized at 3, 4, and 6 Hours After Femoral Arterial Sheath Removal. J Cardiovasc Nurs 2008; 23:407-13. [DOI: 10.1097/01.jcn.0000317452.72402.7c] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tagney J, Lackie D. Bed-rest post-femoral arterial sheath removal - What is safe practice? A clinical audit. Nurs Crit Care 2005; 10:167-73. [PMID: 15997970 DOI: 10.1111/j.1362-1017.2005.00121.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Jenny Tagney
- Camden House, Bristol Royal Infirmary, United Bristol Healthcare Trust, Bristol BS2 8HW, UK.
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Le May M, Kurdi M, Labinaz M, Glover C, So D, Ryan S, Davies R. Safety of coronary stenting with eptifibatide and ultra-low-dose heparin. Am J Cardiol 2005; 95:630-2. [PMID: 15721106 DOI: 10.1016/j.amjcard.2004.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2004] [Revised: 11/04/2004] [Accepted: 11/04/2004] [Indexed: 11/21/2022]
Abstract
With the advent of multiple potent antiplatelet and anticoagulation agents in percutaneous coronary intervention (PCI), the risk of bleeding complications has increased. The optimal dose of unfractionated heparin in this setting is unclear. This study was designed to determine the feasibility and safety of PCI with an ultra-low-dose weight-adjusted unfractionated heparin regimen (30 IU/kg bolus, maximum 3,000 IU) in combination with aspirin, clopidogrel, and eptifibatide. We enrolled 83 patients who underwent nonemergency PCI of native coronary arteries. At 30 days, all patients were free of the primary clinical outcomes defined as a composite of death, myocardial infarction, or repeat target vessel revascularization, and there were no major bleeding complications.
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Affiliation(s)
- Michel Le May
- The University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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Abstract
Percutaneous coronary interventional (PCI) procedures are commonly performed in the United States. The process of caring for this patient population has changed dramatically over the last 10 years, with many of the changes being driven by an evolution in the knowledge base underlying nursing practice. The purpose of this article is to provide a summary and critique of nurse-sensitive outcomes related to patients undergoing PCI procedures and to identify gaps in the literature to provide recommendations for future research. Nursing research on indicators related to costs of care, morbidity, symptom management, functional status, patient/family knowledge, patient responses, behavior, and home/occupational function following PCI are discussed in this review.
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MESH Headings
- Activities of Daily Living
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/economics
- Angioplasty, Balloon, Coronary/nursing
- Angioplasty, Balloon, Coronary/psychology
- Evidence-Based Medicine
- Health Care Costs
- Humans
- Morbidity
- Nursing Evaluation Research/organization & administration
- Outcome Assessment, Health Care/organization & administration
- Patient Education as Topic
- Quality Indicators, Health Care
- Quality of Life
- Recurrence
- Risk Reduction Behavior
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Affiliation(s)
- Barbara Leeper
- Cardiovascular Services, Baylor University Medical Center, Dallas, TX 75246, USA.
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Caussin C, Fsihi A, Ohanessian A, Jacq L, Rahal S, Lancelin B. Direct stenting with 3000 i.u. heparin. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2003; 5:206-10. [PMID: 14630564 DOI: 10.1080/14628840310019616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In order to reduce vascular complications, the authors assessed safety and feasability of a new percutaneous transluminal coronary angioplasty (PTCA) strategy consisting of direct stenting with 3000 i.u. heparin and immediate sheath removal. Predicting factors of vascular complications during PTCA include heparin dosages, sheath dwell time and use of anti-glycoprotein (GP) IIb/IIIa. A simplified PTCA with direct stenting technique may allow the use of very low doses of heparin without anti-GPIIb/IIIa in selected cases. From April 1999 to April 2000 all patients who underwent PTCA in the authors' center were screened. Exclusion criteria comprised a contraindication for direct stenting, primary PTCA for acute myocardial infarction (MI) and a TIMI (thrombolysis in myocardial infarction) grade zero flow. All other patients were included. They received 3000 i.u. heparin before direct stenting whatever their current anticoagulation and their weight. The sheath was immediately removed using manual compression. Out of 716 consecutive PTCA patients, 171 (24%) were enrolled in the study (198 sites). Complete protocol was achieved in 150 patients (88%). Activated clotting time during the procedure was 179 +/- 32 seconds. No subacute thrombosis or creatine kinase elevation was observed before discharge. Only two uncomplicated groin hematomas and two false aneurysms (one surgical repair) were noted. This study shows that direct stenting with 3000 iu heparin is safe. Immediate sheath removal can be performed with a low rate of major vascular complications.
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Abstract
Despite dramatic advances in percutaneous coronary intervention, including coronary stents and potent antiplatelet agents, unfractionated heparin remains the standard procedural anticoagulant. Tradition and habit may have considerable influence over dose selection. A review of the role and dosage of heparin during PCI appears to be overdue
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Affiliation(s)
- G Niccoli
- Department of Cardiology, John Radcliffe Hospital, Headington, Oxford, UK
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Khatri S, Webb JG, Carere RG, Amis A, Woolcott J, Chugh S, Humphries KH. Safety and cost benefit of same-day discharge after percutaneous coronary intervention. Am J Cardiol 2002; 90:425-7. [PMID: 12161237 DOI: 10.1016/s0002-9149(02)02504-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ducas J, Chan MCY, Miller A, Kashour T. Immediate protamine administration and sheath removal following percutaneous coronary intervention: a prospective study of 429 patients. Catheter Cardiovasc Interv 2002; 56:196-9. [PMID: 12112912 DOI: 10.1002/ccd.10195] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We tested the approach of reversing anticoagulation following PCI and immediate sheath removal in 429 consecutive patients. On completion of the PCI, protamine was administered, and the vascular sheath was immediately removed. Stents were used in 364 patients (85%) and GP IIb/IIIa inhibitors were used in 52 patients (12%). Time to achieve hemostasis was 30 +/- 17 min. Minor groin bleeding occurred in six patients. One patient required repair of femoral pseudoaneurysm. Mean creatine kinase at 8 and 16 hr post-PCI were 129 +/- 35 and 145 +/- 32 units, respectively. Creatine kinase rose to > 3 times normal in 12 out of 350 patients (3.4%). Prior to 48 hr, eight patients (1.9%) required emergency PCI or coronary bypass surgery. Follow-up at 30 days observed no deaths and only three target vessel revascularizations (0.7%). In conclusion, immediate reversal of anticoagulation and sheath removal after PCI is safe and feasible.
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Affiliation(s)
- John Ducas
- Section of Cardiology, University of Manitoba Health Sciences Center and St. Boniface Hospital, Winnipeg, Manitoba, Canada.
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Ormiston JA, Shaw BL, Panther MJ, Ruygrok PN, Devlin GP, Stewart RAH, Webster MWI. Percutaneous coronary intervention with bivalirudin anticoagulation, immediate sheath removal, and early ambulation: a feasibility study with implications for day-stay procedures. Catheter Cardiovasc Interv 2002; 55:289-93. [PMID: 11870930 DOI: 10.1002/ccd.10125] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We assessed the feasibility and safety of a strategy of transfemoral percutaneous coronary intervention (PCI) with bivalirudin anticoagulation, immediate sheath removal, early ambulation, and, where possible, same-day discharge in 100 consecutive patients. Ambulation was achieved by 2 hr 30 min in 85% of patients and same-day discharge in 26%. PCI was angiographically successful in 97%. In hospital, there were no deaths or Q-wave myocardial infarctions. One patient suffered a non-Q-wave infarction, another in-hospital surgical revascularization and one required blood transfusion for rectal bleeding. Femoral access site hematoma > 5 cm diameter occurred in two patients. In addition, by 1 month there had been one death (at 10 days) and one pseudoaneurysm treated nonsurgically. In this preliminary study, the strategy of bivalirudin bolus anticoagulation, immediate sheath removal, and 2-hr ambulation after PCI appeared safe, with same-day discharge possible in 26% of unselected patients with stable or unstable angina.
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Swanson N, Hogrefe K, Stephens Lloyd A, Gershlick A. Current perspectives on British use of adjunctive therapies during coronary interventions. Int J Cardiol 2001; 79:119-25; discussion 126-7. [PMID: 11461731 DOI: 10.1016/s0167-5273(01)00446-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Interventional techniques are commonly performed with adjunctive therapy including clopidogrel, ticlopidine, abciximab and heparin. We wished to assess the current British use of antiplatelet and anticoagulant agents as adjunctive therapies in interventional cardiology in the light of the available evidence base regarding their usage. METHODS A simple structured questionnaire was sent between August and October 1999 to all interventional cardiology consultants working in the UK regarding their usage of abciximab (ReoPro), heparin, clopidogrel (Plavix) and ticlopidine (Ticlid) peri-procedurally. RESULTS 68% of consultants responded over the next 4 months, with many replying jointly for a centre rather than individually. Average abciximab use was 8.3% of interventional cases. Eighty-two percent of clinicians used clopidogrel in stented patients. Exact dosages varied considerably. Fifty-three percent of clinicians gave 10000 IU or more of heparin routinely. CONCLUSIONS These figures are not in line with the published evidence and British interventionists appear to have adopted various strategies to target the use of these agents. In particular, abciximab appears to be being administered reactively, as and when problems arise in the catheterisation lab.
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Affiliation(s)
- N Swanson
- Cardiology Clinical Sciences Wing, Glenfield Hospital, Leicester LE3 9QP, UK.
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Head of bed elevation, early walking, and patient comfort after percutaneous transluminal coronary angioplasty. Dimens Crit Care Nurs 2001; 20:44-51. [DOI: 10.1097/00003465-200105000-00013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Semler HJ. Efficacy of invasive vascular closure devices for femoral hemostasis. Am J Cardiol 2001; 87:504. [PMID: 11273364 DOI: 10.1016/s0002-9149(00)01547-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Semler HJ. Femoral hemostasis. Tex Heart Inst J 2001; 28:76-7. [PMID: 11330753 PMCID: PMC101143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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