Early Mobilization After Femoral Approach Diagnostic Coronary Angiography to Reduce Back Pain

Bed Rest Reduction Following Cardiac Catheterizations Using Vascular Closure Devices

BACKGROUND

Bed rest duration following deployment of a vascular closure device after transfemoral left-sided cardiac catheterization is not standardized. Despite research supporting reduced bed rest, many hospitals require prolonged bed rest. Delayed ambulation is associated with back pain, urine retention, difficulty eating, and longer stay.

OBJECTIVE

To study length of stay, safety, and opportunity cost savings of reduced bed rest at a large urban hospital.

METHODS

A single-site 12-week study of 1-hour bed rest after transfemoral cardiac catheterizations using vascular closure devices. Results were compared with historical controls treated similarly.

RESULTS

The standard bed rest group included 295 patients (207 male, 88 female; mean [SD] age, 64.4 [8.6] years). The early ambulation group included 260 patients (188 male, 72 female; mean [SD] age, 64 [9.3] years). The groups had no significant difference in age (t634 = 1.18, P = .21) or sex (χ12=0.2, P = .64). Three patients in the standard bed rest group and 1 in the early ambulation group had hematomas (P = .36). The stay for diagnostic cardiac catheterizations was longer in the standard bed rest group (mean [SD], 220.7 [55.2] minutes) than in the early ambulation group (mean [SD], 182.1 [78.5] minutes; t196 = 4.06; P < .001). Stay for percutaneous coronary interventions was longer in the standard bed rest group (mean [SD], 400.2 [50.8] minutes) than in the early ambulation group (mean [SD], 381.6 [54.7] minutes; t262 = 2.86; P = .005).

CONCLUSION

Reduced bed rest was safe, shortened stays, and improved efficiency by creating opportunity cost savings.

Effects of a back-care bundle for reducing back pain among patients undergoing transfemoral artery coronary angiography: A randomized controlled trial

OBJECTIVE

This study aimed to evaluate the effects of a back-care bundle on back pain in patients undergoing transfemoral coronary angiography (TFA).

METHODOLOGY

This randomized controlled trial was conducted between March and June 2020. Thirty-four patients undergoing TFA were randomly assigned to either the back-care bundle or comparison group. The back pain score was measured using a visual analogue scale at baseline and at 2, 3, 4, and 6 h after TFA. Haemorrhage and subcutaneous thrombosis were assessed using a soft measuring tape immediately after TFA, hourly until the 6th hour, or after participants changed their positions. Generalised linear estimating equation models were used to estimate the effects of the interventions on back pain scores.

RESULTS

The back pain scores in the intervention group decreased significantly over time (mean difference: -0.15; 95 % confidence interval [CI] -0.23 to -0.07; p-value <0.001), while the back pain scores in the comparison group increased significantly over time (mean difference: 1.30; 95 % CI 1.15 to 1.44; p-value <0.001). Overall, the mean difference of back pain scores between the two groups was -2.98 (95 % CI -3.32 to -2.64; p-value <0.001). Haemorrhage and subcutaneous thrombosis were not detected in either group of patients.

CONCLUSION AND RECOMMENDATIONS

The back-care bundle effectively alleviated back pain in individuals undergoing TFA, with varying levels of bleeding risk. However, the effects of the back-care bundle on vascular complications remain unclear. For patients who do not have prolonged bleeding time, the duration of bed rest and the placement of a sand cushion on the puncture site can be reduced. Future trials are needed to develop and examine the effect of interventions in reducing back pain in patients with extended bleeding time.

Evaluation of feasibility and safety of changing body position after transfemoral angiography: A randomized clinical trial

BACKGROUND

Considering the growing number of patients who suffer from cardiovascular and coronary artery disease and the significant importance of angiography in the diagnosis of coronary artery disease, this study investigated the effects of position change on the acute complications of coronary angiography.

METHODS

This study was a randomized clinical trial. Sixty patients undergoing coronary angiography, which was performed by a single operator were selected by convenience sampling method and were assigned to intervention or control groups by randomized block design (30 cases in each group). Intervention group patients' position was changed according to schedule, whereas patients in the control group remained in the supine position in complete bed rest. At the entrance hours, 3, 6, 8, and 24 hours after the angiography, patients in both groups were evaluated in terms of vascular complications, urinary retention, low back pain, groin pain, and comfort. Data were analyzed by repeated measures, Friedman, Mann-Whitney, chi-square, independent t-test, and Kolmogorov-Smirnov tests with SPSS-22.

RESULTS

The two groups did not show any significant difference in terms of demographic, clinical, and preinterventional catheterization characteristics (P > 0.05). There was no significant difference with regard to vascular complications including hematoma (P = 0.149), bleeding (P > 0.01), bruise (P = 0.081), and thrombosis in the two groups of patients during 5 consecutive reviews. However, there was a significant statistical difference regarding low back pain (P < 0.001), groin pain (P < 0.001), urinary retention (P = 0.02), and comfort (P < 0.001).

CONCLUSIONS

The results of this study showed that changing the positions of patients after angiography based on the provided program created no change in the incidence of vascular complications (hematoma, bleeding, thrombosis, and bruise) but resulted in reduced severity of back pain, groin pain, urinary retention, and increased patients' comfort.