Effect of early ambulation after transfemoral cardiac catheterization in Hong Kong: A single-blinded randomized controlled trial

Abstract

Objective: The purpose of the study was to investigate the effect of early ambulation after cardiac catheterization (CC) on patients' back pain, puncture site pain, vascular complications, urinary discomfort, general well-being perception and satisfaction level. Methods: This study was a randomized single-blinded controlled trial. Overall, 137 participants were randomly assigned to experimental (63 participants) or control (74 participants) group according to a computer generated random list. Early ambulation (ambulate at 4 hours post-CC) and routine post-procedure care of 12 to 24 hours were used in the experimental and control groups respectively. Independent t-test, Chi-square test, multiple logistic regression and generalized estimation equation model were applied to compare various outcomes between experimental and control groups. Results: Only one patient in the control group experienced puncture site bleeding after CC. Ambulation at 4 hours after CC significantly reduced patients' back pain 8 hours after they returned to the unit (OR=0.19, 95% CI: 0.08-0.45, p<0.001) and in the next morning (OR=0.36, 95% CI: 0.15-0.87, p=0.023), decrease urinary discomfort (OR=0.35, 95% CI: 0.14-0.90, p=0.03 for "very or unbearable urination discomfort" and OR=0.22, 95% CI: 0.06-0.74, p=0.015 for "much difficulty or unable to urinate at all"), and increase general well-being (p=0.005 for vitality subscale and p=0.014 for the total general well-being). However, it made no significant differences on puncture site pain as well as the satisfaction level of patients. Conclusion: The study enhanced health providers' understanding about the effects of early ambulation on patient outcomes. Nurses may provide more individualized and appropriate care to post-CC patients in a more competent and cost-effective way. (Anadolu Kardiyol Derg 2012; 12: 222-30) Key words: Early ambulation, cardiac catheterization, coronary artery disease, randomized controlled trial, logistic regression analysis 222 ÖZET Amaç: Bu çalışmanın amacı, kardiyak kateterizasyon (KK) sonrası hastanın sırt ağrısına, giriş yeri ağrısına, vasküler komplikasyonlara, idrar rahatsızlığına, genel iyilik algısına ve memnuniyet seviyesine erken ambülasyonun etkisini araştırmaktı. Yöntemler: Bu randomize tek-kör kontrollü bir çalışma idi. Bilgisayarın oluşturduğu random listeye göre, 137 katılımcı, rastgele deneysel (63 katılımcı) ve kontrol (74 katılımcı) gruplarına ayrıldı. Erken ambülasyon (KK sonrası 4. saatte ambülasyon) ve 12 ile 24 saat rutin işlem-sonu bakımı, sırası ile deneysel ve kontrol gruplarında kullanıldı. Bağımsız t-testi, Ki-kare testi, çoklu lojistik regresyon ve genelleştirilmiş tahmin denklem modeli, deneysel ve kontrol grupları arasında çeşitli sonuçları karşılaştırmak için uygulanmıştı. Bulgular: Kontrol grubunda sadece bir hastada, KK sonrası giriş yerinde kanama oldu. Kardiyak kateterizasyon sonrası 4 saatte ambülasyonla üniteye geri dönenlerde: 8. saatte (OR=0.19, p<0.001) ve ertesi sabah (OR=0.36, p=0.023), hastanın sırt ağrısı önemli dere...

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

“…Importantly, complications associated with these advances in mobility were not reported in any of these studies. 3,6,7,[10][11][12][13][14][15] In a recent randomized controlled trial, 2 no significant difference in back pain ratings was found between a control group kept flat and an experimental group allowed changes in HOB elevation, although back pain was measured only in the first hour after angiography in that study. Appendix 3 provides an overview of studies specifically addressing back pain after angiography.…”

“…Bashore et al 9 Coyne et al 10 Rein et al 7 Chair et al 11 Yilmaz et al 12 May et al 13 Rezaei-Adaryani et al 14 Höglund et al 6 Chair et al 3 Bakhshi et al 15 and category 4, femoral artery thrombosis requiring intervention. 23 These guidelines were employed by Chair et al 11 in a 2003 study evaluating the effect of hourly position changes after angiography on vascular complications.…”

“…5 Urinary discomfort and retention are frequent complaints when patients are restricted to a recumbent position. 3 At worst, supine positioning at less than 30˚ head elevation in some high-risk patients can lead to aspiration and impaired oxygenation, especially with the use of sedation. 8 Perhaps most common among patients' complaints, generalized back pain has been reported as a problem during the period of immobilization after removal of a femoral artery sheath.…”

“…8 Perhaps most common among patients' complaints, generalized back pain has been reported as a problem during the period of immobilization after removal of a femoral artery sheath. 3,5,6 Pain management is a contributor to patients' satisfaction with hospitalization, and patients' satisfaction levels are driving many initiatives in the current competitive hospital environment. For these reasons, the restrictions on patients' movement and positioning after angiography have been challenged in recent years.…”

Ambulation following cardiac catheterization: the earlier the better

“…In this well done and clinically relevant study, by Chair et al (7) published in this issue of The Anatolian Journal of Cardiology, the authors evaluate the impact of early ambulation on back pain, puncture site pain, vascular complications, urinary discomfort, general well-being and patient satisfaction in a singleblinded randomized controlled trial performed at a single center in Hong Kong. All study patients underwent catheterization via femoral access and access site hemostasis was achieved by manual compression in all patients.…”