Comparison of the effectiveness of position change for patients with pain and vascular complications after transfemoral coronary angiography: a randomized clinical trial

Abstract

Background Prolonged immobilization after transfemoral coronary angiography (TFA) may cause pain and vascular complications in patients. This study aimed to evaluate the effectiveness of a change in position to decrease pain and vascular complications for patients after TFA. Methods This randomized clinical trial was conducted in 2020. Purposive sampling of 72 eligible patients undergoing TFA were selected and randomly assigned to either an experimental or control group. Patients in the experimental group (EG) were placed in a supine position for 2 h after angiography, followed by a semi-seated position with the bed angle gradually increased to 45° over 4 h. Patients in the control group (CG) remained in the supine position for 6 h. Vital signs, groin, back and leg pain, hematoma, hemorrhage, and urinary retention were assessed in both groups before, immediately after, and over 6 h after angiography. The Visual Analogue Scale was used to measure pain, the Christensen scale to measure hematoma, counting bloody gases to measure hemorrhage, and patient self-rating to determine urinary retention. Results There was no significant difference between EG and CG on score of groin (2.69 ± 1.00 vs. 2.61 ± 1.00, P = 0.74), back (2.19 ± 0.98 vs. 2.47 ± 0.87, P = 0.21), and leg pain (2.14 ± 0.71 vs. 2.50 ± 1.08, P = 0.27) before the TFA. However, from the second hour to the sixth hour after the TFA, the pain in the EG was significantly less than the CG (P < 0.001). So that pain in the groin (1.36 ± 0.48 vs. 3.28 ± 0.81), back (1.25 ± 0.50 vs. 3.81 ± 1.06), and leg (1.44 ± 0.55 vs. 3.28 ± 0.81) for the EG patients was significantly less than the CG in the sixth hour after TFA (P < 0.001). No patients experienced hematoma. No differences were noted between groups in hemorrhage and urinary retention. Conclusions Position change to a semi-seated position in patients after TFA is effective and safe for reduction of pain without increasing vascular complications. Trial registration Iranian Registry of Clinical Trials: IRCT registration number: IRCT20200410047011N1, Registration date: 30/04/2020

Early ambulation protocol after diagnostic transfemoral cerebral angiography: an evidence-based practice project

“…A prospective observational study [ 10 ] demonstrated that for patients who received manual compression after TFA, the modified ambulation protocol including 4 h of immobilization and 6 h time in bed was safe and feasible. In addition to reducing ambulation time, changing patients’ position during immobilization was also proposed by previous research [ 3 , 8 , 19 ]. Two studies [ 3 , 19 ] found that position change to a semi-seated position 2 h after TFA is effective and safe to reduce pain without increasing the vascular complications.…”

“…In addition to reducing ambulation time, changing patients’ position during immobilization was also proposed by previous research [ 3 , 8 , 19 ]. Two studies [ 3 , 19 ] found that position change to a semi-seated position 2 h after TFA is effective and safe to reduce pain without increasing the vascular complications. Though many previous studies have demonstrated the benefits of early ambulation or position change, most protocols are single with the lack of systematization and wholeness (focused on early ambulation or position change only), and multiple interventions are generated based on experiences rather than scientific evidence.…”

“…Digital subtraction angiography (DSA) remains the gold standard for the diagnosis of cerebral vascular diseases, including the transfemoral or transradial artery approach [ 1 ]. Transfemoral cerebral angiography (TFA) is the predominant method in this test because of easy access, less contrast, and less radiation compared with the transradial approach [ 2 , 3 ]. Reportedly, the most common complications associated with TFA are access site complications (e.g.…”

“…), difficulty defecation, and a longer hospital stay [ 4 , 5 ]. In recent years, an increasing number of studies indicate that early ambulation accompanied by changing patients’ position after TFA could effectively reduce patient postoperative discomfort, without an increase in the vascular events [ 3 , 8 – 10 ]. However, the early ambulation protocol varies among different studies, and no uniform consensus has been achieved regarding the duration of bed rest and optimal position after TFA.…”

A Literature Review on Effects of Positioning and Early Ambulation on Coronary Angiography Complication

“…In terms of bleeding and urine incontinence, there are still no changes that occur in both groups. The conclusion of their research says positioning patient in a semi-seated position following TFA decreases pain effectively and safely without worsening circulatory problems [34].…”