Blood Pressure and Risks of Vascular Complications After Percutaneous Coronary Intervention

Construção e validação das competências profissionais do enfermeiro atuante em hemodinâmica

Objetivo: construir e validar as competências profissionais para enfermeiros atuantes em Unidades de Hemodinâmica. Método: trata-se de uma pesquisa metodológica de construção e validação das competências do enfermeiro de hemodinâmica, aprovada pelo Comitê de Ética em Pesquisa sob protocolo nº 67891517.8.0000.5462 e realizada em instituição pública de cardiologia do estado de São Paulo. Na primeira etapa foi realizada a construção do instrumento para identificação das competências do enfermeiro no setor de hemodinâmica a partir de revisão de literatura e observação local e na segunda, a validação do instrumento por especialistas. Os dados foram analisados pelo Índice de Validade de Conteúdo (IVC) e média ponderada do IVC. Resultados: a validação das competências ocorreu após duas rodadas de avaliação junto aos especialistas, resultando um total de sete competências relativas ao processo de trabalho da enfermagem, com média ponderada de IVC entre 88,4 e 99,2 e 74 habilidades, as quais foram classificadas quanto ao tipo de competência, sendo 14 itens avaliados como básicos, 10 como intermediários, 34 como avançados e 16 inconclusivos. Conclusão: as competências profissionais para enfermeiros atuantes em Unidades de Hemodinâmica foram construídas e validadas por especialistas, que poderão subsidiar novas diretrizes acerca da formação e educação permanente dos profissionais nessa área.

Impact of extracardiac vascular disease on outcomes of 1.4 million patients undergoing percutaneous coronary intervention

OBJECTIVES

Extracardiac vascular disease (ECVD) is increasingly recognized as a cardiovascular risk factor, but its association with outcomes after percutaneous coronary intervention (PCI) has not been well characterized.

METHODS

Using the National Inpatient Sample database, all patients undergoing PCI between October 2015 and December 2018 were stratified by the presence and organ-specific extent of extracardiac vascular comorbidity (cerebrovascular disease (CeVD), renovascular, aortic and peripheral arterial disease (PAD)). Primary outcome was all-cause mortality and secondary outcomes were (a) major adverse cardiovascular and cerebrovascular events (MACCE), (b) acute ischemic stroke and (c) major bleeding. Multivariable logistic regression was used to determine the adjusted odds ratios (aOR) and 95% confidence interval (95% CI).

RESULTS

Of a total of 1,403,505 patients undergoing PCI during the study period, 199,470 (14.2%) had ECVD. Patients with ECVD were older (median of 72 years vs. 70 years, p < 0.001) and had higher comorbidity burden that their counterparts. All cause-mortality was 22% higher in patients with any ECVD compared to those without ECVD. PAD patients had the highest odds of all-cause mortality (aOR 1.48, 95% CI 1.40-1.56), followed by those with CeVD (aOR 1.15, 95% CI 1.10-1.19). Patients with extracardiac disease had increased odds of MACCE, ischemic stroke and bleeding, irrespective of the nature or extent (p < 0.05), compared to patients without ECVD.

CONCLUSION

ECVD is associated with worse outcomes in patients undergoing PCI including significantly higher rates of death and stroke. These data should inform our shared decision-making process with our patients.

Implementation of a clinical nursing pathway for percutaneous coronary intervention: A randomized controlled trial protocol

BACKGROUND

Acute myocardial infarction is a very common disease in the emergency room. Emergency percutaneous coronary intervention (PCI) is the first choice to open infarct-related artery in time to regain the active blood flow of myocardial tissue. Clinical nursing pathway (CNP), namely clinical project, is an original nursing mode with good quality, outstanding efficiency, and low treatment spending, so it has attracted more and more attention. However, few studies have reported the implementation of a CNP in PCIs. The purpose of the protocol is to assess the impact of CNP on the clinical efficacy of transradial emergency PCI.

METHODS

This is a randomized controlled, single center trial which will be implemented from January 2021 to June 2021. Hundred samples diagnosed with acute myocardial infarction will be included in this study. It was authorized via the Ethics Committee of Changshan County People's Hospital (CCPH002348). Patients are assigned to the following groups: control group, given normal routine care; CNP group, treated with CNP plan. The time from door to balloon, hospitalization expenses, length of stay, postoperative complications, patients' satisfaction with treatment are compared and analyzed. All data are collected and analyzed by Social Sciences software version 21.0 (SPSS, Inc., Chicago, IL) program.

RESULTS

Differences of clinical outcomes between groups ().

CONCLUSION

This original evidence-based nursing model can be used as the foundation for further research.

TRIAL REGISTRATION NUMBER

researchregistry6030.

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

INTRODUCTION

The purpose was to evaluate the best practice for arterial sheath management in heparinised patients undergoing endovascular intervention for peripheral vascular disease (PVD) at Eastern Health.

METHODS

Patients undergoing endovascular intervention for PVD at Eastern Health between January 2016 and February 2018 were studied. Those who fulfilled the inclusion criteria were randomly assigned to five interventional radiologists and Category A (sheath removed upon return to recovery without activated clotting time (ACT)), Category B (ACT check 1-h postheparin and the sheath was removed without knowing the ACT) or Category C (ACT check 1-h postheparin and sheath removed once ACT < 160; our hospital's current protocol). Nurses removing sheaths independently have >3 years of experience. Data were collected on baseline clinical characteristics, dose of heparin administered, sheath size and direction, time from heparin administration to sheath removal, time to haemostasis, blood pressure at time of sheath removal and complications.

RESULTS

A total of 152 patients were included. About 74% of them were males, and the average age was 72 years. There was no significant difference in baseline characteristics influencing complications and other contributing factors. The only significant finding was that Category C experienced the longest mean time to sheath removal (143.4 ± 52.1 min) while Category A experienced the shortest mean time (62.2 ± 27.1 min, P = 0.0001). There was no significant difference in outcomes.

CONCLUSION

There was no significant difference in the outcomes among all groups, and therefore, it shows no reason to routinely measure ACT to guide sheath removal in heparinised patients undergoing endovascular intervention for PVD.

The effect of the application of cold on hematoma, ecchymosis, and pain at the catheter site in patients undergoing percutaneous coronary intervention

Objective

This study was conducted to determine the effect of the application of cold on hematoma, ecchymosis, and pain in patients undergoing percutaneous coronary intervention.

Methods

It is a quasi-experimental study with a control group. A total of 200 patients (100 in the control group and 100 in the experimental group) were included in the research. In the experimental group, a cold pack was applied to the bottom of the sandbag for the first 15 min after withdrawing the femoral arterial catheter. Both groups were assessed and followed up at the first 15th minute and 4th, 48th and 72 nd h.

Results

After the femoral arterial catheter was withdrawn, ecchymosis and hematoma were smaller and pain was less in the experimental group at the catheter entry site compared to the control group, and the difference was statistically significant (P < 0.01).

Conclusion

It was determined that the application of cold reduced the formation of hematomas, ecchymoses and pain in patients after the withdrawal of the femoral arterial catheter.

Incidence and predictors of groin complications early after coronary artery intervention: a prospective observational study

Background

Coronary artery disease remains the most common single cause of death worldwide. Percutaneous coronary intervention is an appropriate management for coronary artery disease which is not free from its potential complications. The purpose of this study was to determine the incidence rate and the predictors of groin complications post percutaneous coronary intervention in cardiac catheterization laboratories in Jordan.

Methods

This was a prospective observational study with a consecutive sample of 300 patients post percutaneous coronary intervention procedure. Data were collected from the cardiac health care center using a pre-structured observational sheet. Any groin complication developed within the first 24 h post procedure was recorded. All correlated variables were analyzed using logistic regression.

Results

The sample included 237 (79%) men and 63 (21%) women with a mean age of 57.46 ± 10.51 years. A total of 114 patients (38%) developed one or more groin complications. Ecchymosis was the most frequent groin complication; 102 (34%). Females and participants greater than 65 years were nearly two times more likely to develop groin complications (OR = 2.13, P = .024, 95% CI: 1.11-4.01) and (OR = 2.14, P = .023, 95% CI: 1.11-4.13) compared to other groups. Patients with a systolic blood pressure before sheath removal greater than 180 mmHg were about ten times more likely to develop groin complications (OR = 9.82, P = .001, 95% CI: 2.58-37.37).

Conclusions

Different factors can increase the risk of groin complications post percutaneous coronary intervention. Therefore, identification of high risk groups (i.e. females) might help in the application of different methods to control these complications.

Vascular access complications in patients undergoing percutaneous procedures in hemodynamics: a scoping review

OBJECTIVE

To map the production of knowledge on vascular access complications in patients undergoing percutaneous procedures in hemodynamic laboratories.

METHODS

Scoping review study. The search strategy was developed in three stages, considering the period from July 2005 to July 2015 in the PubMed, CINAHL, Scopus, and LILACS databases. The collected data were analyzed and summarized in a narrative form.

RESULTS

One-hundred twenty-eight publications that made it possible to map the contexts of study of complications, occurrence according to access routes, as well as an understanding of diagnosis and clinical management, were included. Three theme categories were identified: complications; predictive factors; and diagnosis/treatment.

CONCLUSION

Vascular access site complications range according to the access route used. Knowledge of factors that permeate the occurrence of these events may contribute to early detection, planning, and monitoring of the care implemented.

Access site complications following transfemoral coronary procedures: comparison between traditional compression and angioseal vascular closure devices for haemostasis

BACKGROUND

Vascular closure devices such as angioseal are used as alternatives to traditional compression haemostasis. Although the safety and efficacy of angioseal are confirmed, their use remains controversial because of the potential complications of these devices compared with those of traditional compression haemostasis. The aim of this study was to compare the access site complication rate, the predictive factors for these complications, and patient comfort levels after coronary procedures with traditional compression or angioseal haemostasis.

METHODS

Data were collected from a cardiac unit in a medical center in northern Taiwan. A total of 130 adult patients were recruited and equally divided into two groups according to the method of haemostasis used after the coronary procedure: a traditional compression group and an angioseal group. We observed the incidence of access site complications, including bleeding, oozing, haematoma formation, and arteriovenous fistula formation. In addition, we used a 0-10 numeric rating scale to assess soreness, numbness, and back and groin access site pain after 1 h of catheter removal and immediately before getting out of bed.

RESULTS

The overall incidence of complications was 3.8 % (n = 5), which was not significantly different between the two groups (p = .06). The propensity score--adjusted multivariate analyses revealed that the only independent predictor for access site complications was an age of >70 years (OR, 10.44; 95 % CI, 1.81-60.06; p = .009). Comfort levels were higher in the angioseal group than in the traditional compression group.

CONCLUSIONS

Angioseal used after coronary procedures did not increase the incidence of complications relative to that associated with traditional compression haemostasis; however, it increased patient comfort levels. Health personnel should pay special attention to the predictive factor for access site complications after coronary procedures, such as age >70 years.

Managing Risk of Complications at Femoral Vascular Access Sites in Percutaneous Coronary Intervention

Percutaneous coronary intervention for acute coronary syndrome or non–ST-elevation myocardial infarction requires the use of potent oral and intravenous anti-platelet and antithrombin medications. Although these potent antithrombotic agents and regimens may increase the effectiveness of percutaneous coronary intervention, they are also generally associated with an increased risk of vascular access complications such as hematoma, retroperitoneal hematoma, pseudoaneurysm, arterial occlusion, and arteriovenous fistula, which in turn are associated with increased morbidity, mortality, and costs. Risk factors predisposing patients to these complications are both modifiable (procedure technique, medications, hemostasis method) and nonmodifiable (sex, age, body mass index, blood pressure, renal function). Patients’ risks can be reduced by nurses who are knowledgeable about these risk factors and identify complications before they become problematic.

Review of nursing care for patients undergoing percutaneous coronary intervention: a patient journey approach

AIM

To evaluate the existing literature to inform nursing management of people undergoing percutaneous coronary intervention. BACKGROUND. Percutaneous coronary intervention is an increasingly important revascularisation strategy in coronary heart disease management and can be an emergent, planned or rescue procedure. Nurses play a critical role in delivering care in both the independent and collaborative contexts of percutaneous coronary intervention management.

DESIGN

Systematic review.

METHOD

The method of an integrative literature review, using the conceptual framework of the patient journey, was used to describe existing evidence and to determine important areas for future research. The electronic data bases CINAHL, Medline, Cochrane and the Joanna Briggs data bases were searched using terms including: (angioplasty, transulminal, percutaneous coronary), nursing care, postprocedure complications (haemorrhage, ecchymosis, haematoma), rehabilitation, emergency medical services (transportation of patients, triage).

RESULTS

Despite the frequency of the procedure, there are limited data to inform nursing care for people undergoing percutaneous coronary intervention. Currently, there are no widely accessible nursing practice guidelines focusing on the nursing management in percutaneous coronary intervention. Findings of the review were summarised under the headings: Symptom recognition; Treatment decision; Peri-percutaneous coronary intervention care, describing the acute management and Postpercutaneous coronary intervention management identifying the discharge planning and secondary prevention phase.

CONCLUSIONS

Cardiovascular nurses need to engage in developing evidence to support guideline development. Developing consensus on nurse sensitive patient outcome indicators may enable benchmarking strategies and inform clinical trial design.

RELEVANCE TO CLINICAL PRACTICE

To improve the care given to individuals undergoing percutaneous coronary intervention, it is important to base practice on high-level evidence. Where this is lacking, clinicians need to arrive at a consensus as to appropriate standards of practice while also engaging in developing evidence. This must be considered, however, from the central perspective of the patient and their family.