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Abstract
PurposeThe purpose of this paper is to explain how trajectory management in hospitals is challenged by the introduction of accelerated discharge schemes. The patient trajectory is formed by short stays within health-care organizations, which requires a substantial effort for professionals to be successful in clarifying each patient's medical situation. The patients, at the same time, often have complicated illness stories, and professionals only see a limited part of the patient's trajectory.Design/methodology/approachThis paper is based on extensive ethnographic studies in a newly established cardiac day unit introducing same-day discharge schemes for patients with ischemic and arrhythmic heart disease.FindingsThe findings demonstrate that the patient trajectory becomes a “temporal patient trajectory” and encounters a short-term reality, where tensions arise between admission time and the trajectory as a whole. In managing temporal patient trajectories, formal organizing and patient experiences intersect in events that emerge from conversations and span past, present and future in relation to patient treatment. Professionals engage in articulation work to maintain coherence by allowing patients to hold different events together over time.Originality/valueThe paper provides new insights into the challenges of managing trajectories in same-day discharge schemes where the pressure to move quickly and ensure patient discharge is intense. The paper offers a novel theoretical perspective on trajectory management as an ongoing temporal process. The analysis displays temporal tensions between patient experiences and the accelerated discharge scheme and how professionals manage to overcome these tensions by bridging the patient's long illness story and the short trajectory within the cardiac day unit.
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Chen Y, Marshall AP, Lin FF. Outcomes of same day discharge after percutaneous coronary intervention: A quality improvement project. Collegian 2021. [DOI: 10.1016/j.colegn.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Taxiarchi P, Kontopantelis E, Kinnaird T, Curzen N, Banning A, Ludman P, Shoaib A, Rashid M, Martin GP, Mamas MA. Adoption of same day discharge following elective left main stem percutaneous coronary intervention. Int J Cardiol 2020; 321:38-47. [PMID: 32739446 PMCID: PMC7392050 DOI: 10.1016/j.ijcard.2020.07.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/04/2020] [Accepted: 07/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study sought to investigate the safety and feasibility of same day discharge (SDD) practice and compare clinical outcomes to patients admitted for overnight stay (ON) undergoing elective left main stem (LMS) percutaneous coronary intervention (PCI). ON observation is still widely practiced in highly complex PCI as the standard of care, with no previous data comparing clinical outcomes in patients undergoing LMS PCI. METHODS We analysed 6452 patients undergoing elective LMS PCI between 2007 and 2014 in England and Wales. Multiple logistic regressions and the BCIS risk model were used to study association between SDD and 30 day mortality. RESULTS SDD rates almost doubled from 19.9% in 2007 to 39.8% in 2014 for all LMS procedures and increased from 20.7% to 41.4% for unprotected LMS cases during the same study period. There was a significant increase in procedural complexity with higher use of rotational atherectomy, longer stents and multivessel PCI. SDD was not associated with increased 30 day mortality (OR 0.70 95%CI 0.30-1.65) in the overall LMS PCI cohort and the results were similar in unprotected LMS (OR 0.48 95%CI 0.17-1.41) and those requiring ON stay (OR 0.58 95%CI 0.25-1.34). CONCLUSIONS We did not find evidence that SDD is not safe or feasible in highly complex LMS PCI procedures despite increasing procedural complexity with no significant increase in 30 day mortality rates.
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Affiliation(s)
- Paraskevi Taxiarchi
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Nick Curzen
- Coronary Research Group, University Hospital Southampton, Faculty of Medicine, University of Southampton, UK
| | | | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Glen P Martin
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Mamas A Mamas
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, University of Keele and Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK.
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Liew S, Dinh D, Liew D, Brennan A, Duffy S, Reid C, Lefkovits J, Stub D. Prevalence, Outcomes and Cost Implications of Patients Undergoing Same Day Discharge After Elective Percutaneous Coronary Intervention in Australia. Heart Lung Circ 2019; 29:e185-e193. [PMID: 31791887 DOI: 10.1016/j.hlc.2019.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/16/2019] [Accepted: 09/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite international growth in the use of same day percutaneous coronary intervention (PCI), its widespread use remains limited. This study sought to determine the prevalence, clinical outcomes and cost implications of same day discharge (SDD) amongst Australian patients undergoing elective PCI. METHODS This is a retrospective, observational cohort study of patients who underwent elective PCI in Victoria between January 2014 and December 2017. Data from this study was obtained from the Victorian Cardiac Outcomes Registry (VCOR). The primary outcome measured was the incidence of 30-day major adverse cardiac events (MACE) and secondary outcomes included in hospital complications and 30-day readmissions, between SDD patients and those observed as inpatients overnight (ON). Propensity score matching for key clinical factors were used to compare both groups. RESULTS We studied 18,101 patients, with a mean age of 68±11years and 13,935 (77%) were male. The rate of SDD was 586 (3.2%) and 17,515 (96.8%) patients stayed in hospital overnight. Radial access was performed in 393 (67.1%) and 7,967 (45.5%) among SDD and ON patients respectively (p<0.001). At 30 days, unplanned cardiac re-hospitalisation occurred in 9.6% (n=56) amongst SDD and 11.6%, (n=2,033) amongst ON patients (p=0.173). Propensity matching highlighted SDD to be non-inferior to overnight, with no significant difference in 30-day MACE (0.5%, 95% CI: 0.34, 1.35) but SDD was associated with reduced average length of stay by 2.06 days (95% CI: 1.94, 2.19). We observed substantial hospital variation for SDD from 0% to 16.6% of elective PCI procedures. CONCLUSIONS Same day discharge after elective PCI is performed infrequently in Victoria. Despite this, SDD appears to be safe and feasible. Given significant benefits in cost and bed utilisation, a more consistent use of SDD could markedly improve the value of PCI care in Australia.
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Affiliation(s)
- Stephanie Liew
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Vic, Australia
| | - Diem Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Angela Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Stephen Duffy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Vic, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Christopher Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Western Health, Melbourne, Vic, Australia; Baker IDI Heart and Diabetes Institute, Melbourne, Vic, Australia.
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Córdoba-Soriano JG, Rivera-Juárez A, Gutiérrez-Díez A, Gutiérrez-Ibañes E, Gallardo-López A, Samaniego-Lampón B, Lozano I, Melehi D, Portero-Portaz JJ, Elízaga J, Jiménez-Mazuecos J. The Feasibility and Safety of Ambulatory Percutaneous Coronary Interventions in Complex Lesions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:875-882. [PMID: 30639420 DOI: 10.1016/j.carrev.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The safety and feasibility of ambulatory PCI has been demonstrated in selected patients with "simple" lesions, but it is not well known whether it could be applied in more "complex" scenarios. METHODS Main objective is to assess the feasibility and safety of ambulatory complex PCI. Prospective multicentre registry of 1047 consecutive patients planned for ambulatory trans-radial PCI. Outcomes in patients with "complex angioplasty" (CA group: 313 (30%)) were analysed and compared with those of "simple angioplasty" (SA group: 734, 70%). The feasibility (% of patients finally discharged) and safety (MACE at 24 h and at 1 month) were compared between groups. We also analyse admissions, visits to the emergency department and minor vascular complications. RESULTS Feasibility was higher for SA (80.6% vs. 63.6%, OR 1.89, 95% CI 1.52-2.35, p < 0.001). Ambulatory PCI was very safe in both groups. In CA no MACE occurred at 24 h (vs. 0.17% SA) or 30 days (vs. 0.68% in SA). There were also no differences in re-admissions, visits to the emergency department or minor vascular complications (there was a non-significant tendency to higher rate of radial occlusion at 1 month in the CA group, 5.5% vs. 2.7%, p: 0.07). CONCLUSIONS The feasibility of ambulatory PCI in selected patients with complex lesions is lower than in simple lesions, however when it is possible, it is as safe as in selected patients with simple lesions.
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Affiliation(s)
| | | | | | | | | | | | - Iñigo Lozano
- Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Driss Melehi
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | - Jaime Elízaga
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Implementing Same Day Discharge Following Percutaneous Coronary Intervention: A Process Evaluation. J Nurs Care Qual 2018; 34:54-60. [PMID: 29912023 DOI: 10.1097/ncq.0000000000000337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The safety and effectiveness of same day discharge (SDD) following percutaneous coronary intervention are well demonstrated; however, the uptake of this model of care is low. PURPOSE The aim was to examine the effectiveness of implementing SDD using a process evaluation methodology. METHODS This study was undertaken in a cardiac services department of a tertiary teaching hospital in southeast Queensland, Australia. It was anticipated before the implementation that 120 patients could be discharged the same day in a 6 months' time period. Patient selection process and guideline adherence were assessed along with patients' and relatives' satisfaction. RESULTS During implementation, 22 patients were discharged home the same day. It was found that staff did not follow the guideline consistently, with an overall adherence of 77.3%. CONCLUSION The uptake of SDD was low in this implementation. The study is important as it provides direction for future improvement both in the criteria and the implementation process.
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Abstract
BACKGROUND Overnight observation is the standard of care for uncomplicated elective percutaneous coronary intervention (PCI). However, same-day discharge (SDD) is reportedly safe using predetermined criteria and patient risk categories. Characteristics of patients with SDD have not yet been described. OBJECTIVE The purpose of this study was to describe the phenotype of patients appropriate for SDD after PCI without predetermined criteria and patient risk categories. METHODS Analysis of PCI registry data was conducted on patients (n = 2174) who underwent elective and nonelective PCI between January 2012 and June 2014. Preliminary analysis included descriptive statistics, t tests, and χ tests. All variables were analyzed using random forest plot to determine importance of predictors of SDD followed by confirmatory logistic regression. RESULTS Random forest plot indicated 6 predictors of SDD. Confirmatory logistic regression using a model with all 6 predictors indicated that the model was able to distinguish between patients with SDD and overnight observation after PCI and was statistically significant (χ(7.12, N = 2174) = 511.12, P < .005). Strongest predictors of SDD were stable angina (odds ratio, 5.93 [95% confidence interval, 1.316-26.712]; P = .020) followed by non-ST elevation myocardial infarction/high-risk unstable angina (odds ratio, 1.66 [95% confidence interval, 1.239-2.225]; P = .001). Readmission within 24 hours of SDD after PCI was low at 0.91%. CONCLUSIONS Age, access site, complexity, and number of lesions stented did not preclude SDD. A broader range of patients, particularly patients in higher risk categories (non-ST elevation myocardial infarction and unstable angina), are candidates for SDD.
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Seguridad y factibilidad de la intervención coronaria percutánea ambulatoria en pacientes seleccionados: datos de un registro multicéntrico español. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.09.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Safety and Feasibility of Outpatient Percutaneous Coronary Intervention in Selected Patients: A Spanish Multicenter Registry. ACTA ACUST UNITED AC 2017; 70:535-542. [PMID: 28254362 DOI: 10.1016/j.rec.2017.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/26/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES The exponential increase in coronary interventions plus the generalization of the radial approach represent the ideal scenario for starting outpatient angioplasty programs with the aim of reducing the costs while maintaining safety. This article reports data from a multicenter Spanish registry on fully ambulatory transradial angioplasty in selected patients for the first time. METHODS Prospective registry of elective outpatient transradial-ulnar angioplasty in patients with stable coronary disease. Patients were discharged the same day and were followed up at 24hours and 30 days. Safety and feasibility were analyzed. RESULTS Of the 723 patients included (76% male; age, 66.6±10.5 years), 533 (73.7%) were finally discharged after 4 to 12hours of surveillance. Among the remaining 190 (26.7%) patients, the most common reason for hospitalization was clinical instability after the procedure (60.5%). Independent predictors of admission were a history of peripheral artery disease, a higher baseline creatinine level, ad hoc performance of the procedure, and multivessel disease. At 24hours, there was 1 major adverse event in 1 patient (0.19%), who required hospitalization for major bleeding not related to vascular access. At 30 days, there were 3 major adverse events (0.56%): 1 subacute stent thrombosis, 1 revascularization of a vessel other than the treated vessel, and 1 minor stroke. Eight patients (1.5%) required admission at 30 days. CONCLUSIONS The application of an outpatient transradial-ulnar angioplasty program with discharge after 4 to 12 hours' surveillance is safe and feasible in well-selected patients.
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Koutouzis M, Agelaki M, Maniotis C, Dimitriou P, Tsoulmeleas A, Matsoukis I, Andreou C, Lazaris E. Predictors of same day discharge after percutaneous coronary interventions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:241-244. [PMID: 28089776 DOI: 10.1016/j.carrev.2017.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/29/2016] [Accepted: 01/05/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study is to identify possible predictors for same day discharge (SDD) after percutaneous coronary interventions (PCI). BACKGROUND Same day discharge after PCI is becoming more and more appealing and patient's selection criteria are being formulated. METHODS A retrospective analysis was performed in all PCI procedures from January 2013 until December 2015. Patients were discharged the same day (SDD group) or had at least one overnight stay (non-SDD group). The decision of SDD or not was on treating physician discretion. We evaluated predictors of SDD decision by a logistic regression analysis. RESULTS One thousand one hundred sixty eight procedures were performed from our department during the study period: 308 patients (26.4%) were discharged the same day (SDD group) and the rest 860 procedures (73.6%) had at least one overnight stay (non-SDD group). Multivariate analysis revealed that forearm approach (OR=5.498, CI: 2.067-14.629; p=<0.001), patient's residency proximal to the hospital (OR=4.543, CI: 2.406-8.580; p<0.001), completion of the procedure before 13,00p.m. (OR=3.437, CI: 1.789-0.6.601; p<0.001) and the success of the performed procedure (OR=1.125, CI 1.043-2.135; p=0.044) were positive predictors of SDD, while presentation with non-ST elevation myocardial infarction or unstable angina (OR=0.542, CI: 0.268-0.872; p<0.010) and amount of contrast used (OR=0.910, CI: 0.852-0.969; p<0.030) were negative predictors of SDD. CONCLUSION In retrospect, both procedural and demographic details play a crucial role in patient selection for same day discharge post coronary percutaneous intervention.
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Affiliation(s)
- Michail Koutouzis
- Second Cardiology Department, Hellenic Red Cross Hospital, Athens, Greece.
| | - Maria Agelaki
- Second Cardiology Department, Hellenic Red Cross Hospital, Athens, Greece
| | - Christos Maniotis
- Second Cardiology Department, Hellenic Red Cross Hospital, Athens, Greece
| | | | | | - Ioannis Matsoukis
- Second Cardiology Department, Hellenic Red Cross Hospital, Athens, Greece
| | | | - Efstathios Lazaris
- Second Cardiology Department, Hellenic Red Cross Hospital, Athens, Greece
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Chen Y, Marshall A, Lin F. Implementation Strategies for Same Day Discharge Post Percutaneous Coronary Intervention: An Integrative Review. Worldviews Evid Based Nurs 2016; 13:371-379. [PMID: 27171576 DOI: 10.1111/wvn.12163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Same day discharge following percutaneous coronary intervention has emerged worldwide to enhance discharge efficiency and decrease length of stay. However, uptake of this practice is variable and strategies to support its implementation have not been examined. RESEARCH QUESTION Among patients who undergo nonurgent percutaneous coronary intervention, what components are included in and which strategies are used to facilitate the implementation of same day discharge in clinical practice? METHODS An integrative review was conducted. Keywords including same day discharge, outpatient, percutaneous coronary intervention, outpatient coronary stenting were used to search databases including Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBase, Cochrane, and Medline between 1990 and 2014. Data were extracted and summarized specific to: (a) components of same day discharge, (b) patient selection, and (c) strategies used to implement same day discharge. RESULTS Nineteen articles were included that provided information about implementation strategies for same day discharge. Variability was identified in how same day discharge was operationalized, how patients were selected, and the strategies that were used to implement same day discharge. Culture, patient preference, and acceptance of same day discharge were important for its implementation. Guideline or protocol, physical environment, champion, education, audit or feedback, and team building were all found to be important strategies in implementing same day discharge. LINKING EVIDENCE TO ACTION The results of this integrative review inform our understanding of how same day discharge is operationalized and what strategies can be used to implement same day discharge. The findings of the review highlight that there is a need for more research examining implementation strategies in a detailed manner that can assist others to introduce and sustain same day discharge in routine practice.
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Affiliation(s)
- Yingyan Chen
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Southport, QLD, Australia.
| | - Andrea Marshall
- Professor of Acute and Complex Care Nursing, School of Nursing and Midwifery; NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalized Patients (NCREN), Menzies Health Institute Queensland; Gold Coast Hospital and Health Service, Nursing and Midwifery Education and Research Unit, all at Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Frances Lin
- Program Director, Senior Lecturer, School of Nursing and Midwifery, and Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
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Clavijo LC, Cortes GA, Jolly A, Tun H, Mehra A, Gaglia MA, Shavelle D, Matthews RV. Same-day discharge after coronary stenting and femoral artery device closure: A randomized study in stable and low-risk acute coronary syndrome patients. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:155-61. [DOI: 10.1016/j.carrev.2016.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/29/2016] [Accepted: 03/07/2016] [Indexed: 12/29/2022]
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Filipiak-Strzecka D, Michalski B, Kasprzak JD, Lipiec P. Pocket-size imaging devices allow for reliable bedside screening for femoral artery access site complications. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2753-2758. [PMID: 25308945 DOI: 10.1016/j.ultrasmedbio.2014.06.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/08/2014] [Accepted: 06/30/2014] [Indexed: 06/04/2023]
Abstract
The aim of this study was to validate pocket-size imaging devices (PSIDs) as a fast screening tool for detecting complications after femoral artery puncture. Forty patients undergoing femoral artery puncture for arterial access related to percutaneous coronary intervention were enrolled. Twenty-four hours after percutaneous coronary intervention, the involved inguinal region was assessed with PSIDs enabling 2-D gray-scale and color Doppler imaging. Subsequently, examination with a stationary high-end ultrasound system was performed to verify the findings of bedside examination in all patients. In 37 patients, PSID imaging had good diagnostic quality. False aneurysms (one asymptomatic) occurred in four patients, and all were recognized during bedside screening with PSID. One case of femoral artery thrombosis was confirmed with PSID and during standard ultrasonographic examination. Physical examination augmented with the quick bedside PSID examination had a sensitivity of 100% and specificity of 91%. PSID facilitated rapid bedside detection of serious access site complications in the vast majority of patients, including asymptomatic cases.
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Affiliation(s)
| | - Błażej Michalski
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | | | - Piotr Lipiec
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
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Cohen JE, Moshe Gomori J, Anner H, Itshayek E. Inadvertent subclavian artery cannulation treated by percutaneous closure. J Clin Neurosci 2014; 21:1973-5. [DOI: 10.1016/j.jocn.2014.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 04/21/2014] [Indexed: 10/25/2022]
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Larsen EN, Hansen CB, Thayssen P, Jensen LO. Immediate mobilization after coronary angiography or percutaneous coronary intervention following hemostasis with the AngioSeal vascular closure device (the MOBS study). Eur J Cardiovasc Nurs 2013; 13:466-72. [PMID: 24336239 DOI: 10.1177/1474515113516702] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients undergoing coronary angiography or percutaneous coronary intervention (PCI), the standard post procedure regime includes immobilization and bed rest despite the use of vascular closure devices. AIM In the Mobilization after Coronary Angiography or Percutaneous Coronary Intervention (MOBS) study we compared bleeding complications after cardiac catheterization with femoral artery access after mobilization immediately off the angiographic table or standard care with1 hour (MOBS I after a diagnostic angiogram) or 2 hours of bed rest before mobilization (MOBS II after PCI). METHODS Bleeding complications were defined as major (requiring surgery of the femoral artery, transfusion or increased hospital stay) and minor (hematoma <5 × 5 cm(2), oozing from the puncture site or minor bleeding that could be compressed manually). RESULTS In the MOBS I cohort (100 patients were mobilized immediately and 100 patients followed standard care) no major bleeding complications were seen. In the immediate mobilization group 2.0% experienced minor bleeding compared to 4.0% in the standard care group (p=0.41). In the MOBS II cohort after PCI (158 patients were mobilized immediately and 161 patients followed standard care), major bleeding complication rates did not differ significantly between the two groups: immediate mobilization group 26.6% vs. standard care group 28.0%, p=0.78. The majority of bleeding complications were due to oozing: immediate mobilization group 22.8% vs. standard care group 20.5%, p=0.62. CONCLUSIONS Immediate mobilization after a coronary angiogram or PCI with the femoral access site closed by the closure device AngioSeal was not associated with increased bleeding risk compared to standard care with bed rest.
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Affiliation(s)
| | | | - Per Thayssen
- Department of Cardiology, Odense University Hospital, Denmark
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