Nursing interventions to decrease bleeding at the femoral access site after percutaneous coronary intervention. SANDBAG Nursing Coordinators. Standards of Angioplasty Nursing Techniques to Diminish Bleeding Around the Groin

Abstract

BACKGROUND: This trial is the first prospective, multicenter clinical nursing trial conducted to measure the effect of nursing interventions on bleeding at the femoral access site after percutaneous coronary intervention with or without a potent antiplatelet agent given along with heparin and aspirin. OBJECTIVE: To measure the relationship between nursing interventions and complications at the arterial access site in patients undergoing percutaneous coronary interventions and to recommend a standard of care to minimize bleeding complications. METHODS: In a descriptive, correlational 4010-patient study, nursing care interventions after coronary procedures were measured. Observed standards of care were assessed, and regression techniques were used to evaluate nursing interventions and the effect of the interventions on bleeding at the access site after percutaneous coronary procedures. RESULTS: Several significant correlations between nursing interventions and the occurrences of moderate to severe bleeding at the access site were found; however, most interventions had little effect. The most significant factors in decreasing complications at the access site were early removal of the arterial sheath, the type of pressure mechanism used to achieve arterial hemostasis, staffing allocation, and the person and method used to remove the sheath. CONCLUSION: Many nursing interventions after percutaneous coronary intervention have become routine in the absence of clinical outcome data. Most nursing interventions aimed at decreasing bleeding at the vascular access site increase nursing workload but do not significantly affect bleeding in the groin. These results underscore the importance of continued clinical research studies to validate nursing practice on the basis of patients' outcomes.

Is activated clotting time necessary to guide sheath removal in heparinised patients undergoing endovascular intervention for peripheral vascular disease?

“…Given that there was no significant difference in baseline characteristics influencing complications and other contributing factors, it raises the question as to whether the use of ACT to guide sheath removal is necessary as it may delay sheath removal and thus contribute to patient discomfort and infection risk . Unfortunately, given the paucity of data regarding primary event rates in patients with ACT guided sheath removal, sample calculation could not be performed to determine non‐inferiority.…”

“…Moreover, there is no international standard for an ACT level considered safe for sheath removal in heparinised patients and therefore no standardised protocol for hospitals to adopt . The variation in ACT level considered safe for sheath removal amongst hospitals have resulted in differences in sheath dwell times of up to at least 2 hours, and it has been shown that longer sheath dwell time increases the risk of bleeding and patient discomfort . Thus, the purpose of this study was to determine whether ACT level is an important factor in influencing patient care as otherwise we may be delaying sheath removal unnecessarily.…”

An assessment of cardiac nurses' knowledge and practices regarding patient safety after cardiac catheterization

“…The relevant literature review for the study is covered in the following sections: Study on the nursing practices and care given to patients who have had cardiac catheterization, Evaluation of cardiac nurses' performance, and Studies on the detection and management of complications throughout cardiac catheterization. Juran et al (1999) conducted a study on the nursing interventions to decrease bleeding at the femoral access site after PCI. The goal of the research is to establish a baseline of care to reduce bleeding complications and assess the association between nursing interventions and complications at the arterial access site in PCI patients.…”

Why Cardiology Nurses Should Worry about Vascular Complications and Arterial Access

“…Although someone still may argue that “cardiologists do it better”, sheath removal by experienced nurses proved to be feasible and safe. Indeed, manual compression, with or without the aid of mechanical clamps, is wearying but relatively easy to learn and practice, and, when correctly performed, it bears a low risk of complications [3]. Closure devices are, instead, more complex, they require a rigorous learning curve, they are more expensive and they do not persuasively reduce the incidence of vascular complications in comparison to “good old” manual compression.…”