[Safety and efficacy of an early deambulation protocol after PTCA with an angio-seal device]

[Cardiac catheterism. Nursing performance in the critical unit]

In acute myocardial infarction (AMI), ischemia is acute, intense and maintained, it being one of the main causes of death in our society. Immediate treatment may reduce it considerably. The objectives established in this study were the following: Verify the course of the AMI treatments Verify the evolution in hemostatic methods in patients subjected to cardiac catheterism. Elaborate new nursing protocols for pre- and post-catheterism care. A retrospective, descriptive study was done. From October 1999 to December 2002, a total of 1969 patients were admitted to our unit. Of these, 818 were admitted due to heart disease. Those whose diagnosis was AMI or Angina were selected among the latter and then those in whom cardiac catheterism was done were chosen. It was conducted in a 12 bed polyvalent ICU, the data collection being done by five nurses from that unit based on clinical and nursing history. An increase in the performance of diagnostic and therapeutic cardiac catheterism in recent years was observed, and there was also an increase in intraarterial suture as hemostasis method in detriment to mechanical compression. New standardized nursing products were elaborated to facilitate and improve the care of these patients and try to reduce preparation time for their transfer to the hemodynamics unit, given the urgency existing in most of the cases.

[Complications with femoral access in cardiac cathetization. Impact of previous systematic femoral angiography and hemostasis with VasoSeal-ES collagen plug]

INTRODUCTION AND OBJECTIVES

Most cardiac catheterizations are performed via femoral artery access, and hemostatic devices are commonly used. We evaluate the relationship between the strategy used for femoral arteriography and the use of VasoSeal-ES, and local vascular complications.

PATIENTS AND METHOD

Prospective study of 540 consecutive catheterizations with systematic femoral artery and sheath angiography. VasoSeal-ES was used in 427 patients. Predictors of local vascular complications such as patient-related factors, anatomy and hemostasis were analyzed. Variables related to failure of the collagen plug were also studied.

RESULTS

Punctures of the common femoral artery occurred in 35.9% of all patients (16% in the deep femoral artery and its ostium). Spasm was evident in 18% (ranging from 58.1% in the deep femoral artery to 5.2% in the common femoral artery). Puncture at the site of ramification was seen in 11.3%. Angiographically significant atheroma was seen in 17.8%. The femoral head was a valid landmark for the common femoral artery in only 63.9% of the pateints. Risk factors for local vascular complications were punctures of the common femoral artery, female sex and failure of VasoSeal-ES to achieve hemostasis (15.8% in the first two months of use, 5.2% in the last months of the study). Complications involving superficial and deep femoral arteries occurred in 6.7% and 1.2% of the patients, respectively, in contrast to 0.6% involving the common femoral artery. Variables related to collagen plug failure were patient-related factors, weight less than 55 kg, operator-related factors and the learning curve.

CONCLUSIONS

Systematic femoral angiography provides data that aids the choice of the best hemostasis procedure to reduce local vascular complications. Punctures of the common femoral artery were more frequent than expected, and were associated with a higher complication rate. VasoSeal-ES is a safe and useful method of hemostasis, and its infrequent failures were associated with high complication rates that were substantially reduced with experience.