Levels of Pain in Patients Undergoing Coronary Invasive Procedures in Trans-Radial Versus Trans-Femoral Approaches: A Cross-Sectional Study

Abstract

Trends for invasion site for coronary interventions are shifting from femoral to radial approach because of the advantageous effects. Assessment of pain associated with puncture site in both approaches (radial/femoral) is important. Purpose of this study is to find the difference in post procedural access site pain in patients undergoing coronary invasive procedures in trans-radial versus trans-femoral approach and its association with age, gender and BMI. A cross-sectional study was conducted with 75 randomly selected patients who underwent coronary invasive procedures. A structured questionnaire used for demographic and biophysical data, procedural data and Numerical Pain Rating Scale to assess the pain. Out of 75 patients 42 patients received trans-femoral access and 33 received trans-radial access. Post procedural access site pain in trans-femoral site felt at mild and moderate level 64.2% vs. 23.8 % respectively. While on same rating scale in radial group felt at mild and moderate level 42.4% vs. 33.3 % with p-value 0.611 (>0.05). The mean difference in gender with males 69.3 % versus females 30.6 % showed from analysis that both sexes felt pain at mild level on pain rating scale resulting p-value 0.046 (< 0.05). Statistically significant level of pain was associated with obese patients resulting p -value 0.299 (> 0.05). Patient undergoing coronary intervention through femoral site invasion experience more post procedural access site pain than radial site invasion. Pain level is increased in obese and aged population.

Patient comfort in percutaneous coronary interventions

“…A study carried out in Lahore in 2021 determined that those with post-angiography femoral access experienced more local pain and more discomfort compared to those with radial access. 15 In the study performed by Fens 12 (2015) in the Netherlands, patients who underwent both radial and femoral interventions were questioned, 2 vascular access routes were compared based on the patient's perspective, and no access route was found to be superior. It was indicated that the vascular access decision was a preference-sensitive decision and that the importance of the procedure's features might vary according to the patient.…”

“…Interventions with radial artery access are preferred due to its aspects such as fewer complications at the site of access, early mobilization, early discharge, low cost, and improved quality of life. 11,12,15 Although many sources emphasize that transradial angiography increases success, reduces the time of procedure, and is preferred by patients, it has also been mentioned that its use is limited due to the length of the procedure and procedural failure. 15 Furthermore, treatment with transfemoral vascular access reported to bring higher cost of procedures, higher complication rates and longer time spent at hospital.…”

“…11,12,15 Although many sources emphasize that transradial angiography increases success, reduces the time of procedure, and is preferred by patients, it has also been mentioned that its use is limited due to the length of the procedure and procedural failure. 15 Furthermore, treatment with transfemoral vascular access reported to bring higher cost of procedures, higher complication rates and longer time spent at hospital. 7,11,12,16 There are studies involving pain assessment after coronary interventions for nursing care.…”

“…Nurses can help patients decide on the access point. 15 Anxiety can be reduced by adequately informing the patient, and an independent decisionmaking process is also supported. This study aimed to identify comfort levels of the patients experiencing PCI, and to determine whether different vascular access methods affect the comfort level.…”

Patient Comfort in Transradial and Transfemoral Percutaneous Coronary Interventiıon

“…Interventions with radial artery access are preferred due to its aspects such as fewer complications at the site of access, early mobilization, early discharge, low cost, and increased quality of life. 11,12,15 Although it is emphasized in many sources that transradial angiography increases success, reduces the procedure time, and is preferred by patients, it has also been mentioned that its use is limited due to the length of the procedure and procedural failure. 15 It has been demonstrated that the cost of procedures and the complication rate are higher, and the length of hospital stay is longer in patients treated with transfemoral vascular access.…”