Zeler KM, McPharlane TJ, Salamonsen RF. Effectiveness of nursing involvement in bedside monitoring and control of coagulation status after cardiac surgery.
Am J Crit Care 1992;
1:70-5. [PMID:
1307893]
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Abstract
OBJECTIVE
This study explores: (1) the feasibility of involvement of nursing staff in routine bedside testing of activated clotting time and (2) joint implementation with resident medical staff of a preformulated plan for management of mediastinal bleeding after cardiac surgery.
DESIGN
Patients were divided randomly into two groups, an experimental group (n = 108) subjected to ACT testing and management by protocol, and a control group (n = 146) treated by independent medical decisions.
RESULTS
Bleeding, volume of blood replaced, abnormal coagulation profiles and reoperations to control bleeding and its consequences were all reduced in the study group.
CONCLUSION
We concluded that bedside measurement of activated clotting time by nursing staff, associated with therapy based on a flow diagram, enhanced the overall management of early mediastinal bleeding after cardiac surgery as compared with independent management decisions by resident medical staff. In addition, the method provided a sensitive and reliable means of detecting and correcting rebound heparinization in the early postoperative period.
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