Comparison of Head Elevation Protocols Following Femoral Artery Sheath Removal After Coronary Angiography

Abstract

OBJECTIVES To compare 2 standard protocols for head elevation following removal of a femoral artery sheath after coronary angiography and their effects on bleeding complications and reported levels of back pain. One protocol involved flat supine bed rest; the other allowed progressive head elevation. METHODS A prospective comparative study of 80 adult patients undergoing coronary angiography via the femoral approach. The Numeric Rating Scale was used as the measure of reported pain. RESULTS No bleeding complications occurred in either group. Both groups had very low mean pain scores. Repeated-measures analysis demonstrated that the experience of pain differed significantly over time by location (F 5,70 = 3.864, P = .004), with a notable decrease in pain scores more than 1 hour after sheath removal at the location that used the progressive head elevation protocol. Patients' satisfaction scores after discharge did not differ significantly between the 2 groups. Patients with a history of chronic back pain had consistently higher pain scores, but those pain scores did not differ significantly by location (or protocol). CONCLUSIONS It appears that using a progressive head-elevation protocol within the first 3 hours after diagnostic angiography is not associated with an increased risk of bleeding complications at the access site and warrants further exploration in the mitigation of back pain associated with prolonged supine bed rest. (Critical Care Nurse. 2016;36[3]:20-35)

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

“…In this study, it was seen that the application of cold after PCI decreased the incidence of pain in the femoral artery region. In other studies, pain associated with coronary angiography developed mostly on the back during catheter withdrawal and at rest [2,14,32,52,53]. In addition, the patients reported that the use of a sandbag and staying in bed for a long time was disturbing and painful [35].…”

Understanding the patient experience of pain and discomfort during cardiac catheterization

“…[10][11][12] Most studies outline predictors and interventions to address musculoskeletal pain associated with cardiac catheterization, aimed at postprocedural care (bedrest, positioning, etc). [11][12][13] Our findings add to the existing literature by demonstrating that procedural sedation administration practices may practicably reduce the overall total dosage of procedural sedation medications required, without compromising patient satisfaction or comfort.…”

“…A literature search of contemporary studies that characterize subjective patient experiences during invasive cardiac procedures revealed few articles, and the majority of available studies fail to fully capture important differences in intraprocedural factors . Most studies outline predictors and interventions to address musculoskeletal pain associated with cardiac catheterization, aimed at postprocedural care (bedrest, positioning, etc) . Our findings add to the existing literature by demonstrating that procedural sedation administration practices may practicably reduce the overall total dosage of procedural sedation medications required, without compromising patient satisfaction or comfort.…”

The Relationship Between Hip and Knee Flexibility and Post-coronary Angiography Pain

“…The study showed that the intervention group, who had early mobility and position changes earlier than 6 hours, reported less urinary retention and less average pain [8]. However, another study has found that changing the patient's position did not affect the severity of back pain in patients with back pain [9]. Studies have shown that early mobilization of patients after angiography results in fewer pain symptoms, fewer postoperative complications, and higher satisfaction [10][11][12][13][14].…”