Nursing-led ultrasound to aid in trans-radial access in cardiac catheterisation: a feasibility study

Nurse-led intervention in the management of patients with cardiovascular diseases: a brief literature review

Coronary artery disease (CAD) is one among the major causes of mortality in patients all around the globe. It has been reported by the World Health Organization (WHO) that approximately 80% of cardiovascular diseases could be prevented through lifestyle modifications. Management of CAD involves the prevention and control of cardiovascular risk factors, invasive and non-invasive treatments including coronary revascularizations, adherence to proper medications and regular outpatient follow-ups. Nurse-led clinics were intended to mainly provide supportive, educational, preventive measures and psychological support to the patients, which were completely different from therapeutic clinics. Our review focuses on the involvement and implication of nurses in the primary and secondary prevention and management of cardiovascular diseases. Nurses have a vital role in Interventional cardiology. They also have major roles during the management of cardiac complications including congestive heart failure, atrial fibrillation and heart transplantation. Today, the implementation of a nurse-led tele-consultation strategy is also gaining positive views. Therefore, a nurse-led intervention for the management of patients with cardiovascular diseases should be implemented in clinical practice. Based on advances in therapy, more research should be carried out to further investigate the effect of nurse-led clinics during the long-term treatment and management of patients with cardiovascular diseases.

Nurse-led distal radial access: efficacy, learning curve, and perspectives of an increasingly popular access. Does learning by doing apply to both the doctor and the nurse?

BACKGROUND

The distal radial represents an evolution of the standard radial approach. Distal radial arterial access (DRA) in the so-called "anatomical snuffbox" is technically more difficult but offers potential advantages for patients. Moreover, the use of the distal radial would preserve the proximal radial from the risk of arterial occlusion after interventional procedures performed through the radial artery.

METHODS

We enrolled 100 consecutive elective patients undergoing cardiac catheterization (diagnostic or procedural). Arterial access to the distal radial was entirely managed by nursing staff supervised by the interventional cardiologist. In this single-centre single-operator experienced study, the same nurse operator performed puncture, wiring, and sheath advancement.

RESULTS

The technical feasibility was 89% and the failure rate occurred in the first 50 cases as evidenced by the learning curve. There were no major complications and the rate of minor complications is in line with that of the radial literature. BMI (OR 1.19; 95% CI: 1.03-1.38), non-radial dominance (OR 3.5; 95% CI: 1.04-12.3) and operator's experience (OR 0.59; 95% CI: 0.35-0.99 for every 20 consecutive cases performed) were associated with DRA failures.

CONCLUSIONS

The experience is encouraging and beneficial for all staff and patients with a high percentage of technical success and few mild complications.