Effect of Positioning and Early Ambulation on Coronary Angiography Complications: a Randomized Clinical Trial

Vascular outcomes of early deflation of radial artery band following coronary angiography: A controlled clinical trial

The present study aimed to investigate the effect of early deflation of the transradial (TR) band on the vascular outcomes of patients who have undergone coronary angiography through transradial access (TRA). The present controlled clinical trial included all patients who had undergone elective coronary angiography through TRA. The participants (n=70) met the inclusion criteria and were selected using convenient sampling. Then, they were randomly assigned to the intervention and control groups, using block randomization. Data collection tools included a questionnaire on demographic and related clinical data, including the history of diabetes, hypertension, hypercholesterolemia, heart failure and vascular disease, and the checklist of post-angiographic complications, including duration of the procedure, systolic and diastolic blood pressures measured before and after the procedure, and assessments of radial artery occlusion (RAO), hematoma and pain. The intervention group had their TR band on the artery for 1.5 hours after the procedure. Then, the cuff of the band was deflated at a speed of 5 cc every 15 minutes, using a syringe. However, the TR band was kept in place for 2 hours in the control group, followed by the deflation with the same speed. The pressure application time was recorded in both groups from the removal of sheaths until complete hemostasis. The patients with early deflation of the TR band experienced less pain compared to those with typical deflation (P=0.003). However, the variables of hematoma development (P=0.062) and RAO (P=0.371) were not significantly different between the patients with typical and early deflation of the TR band. The present study concluded that the patients with early deflation of the TR band experienced less pain compared to those with typical deflation. Therefore, deflating the TR band after cardiac angiography at 1,5 hours has similar efficacy and safety compare to 2 hours and associated with less reported pain score.

The Relationship Between Perioperative Care Quality and Postoperative Comfort Level in Patients With Hip Replacement Surgery

PURPOSE

To examine the relationship between perioperative care quality and postoperative comfort level of patients undergoing hip replacement surgery.

DESIGN

This is a descriptive study.

METHODS

This study was conducted with 90 patients between February and September 2021 in a training and research hospital in Turkey. Data were collected from Information Form, the Good Perioperative Nursing Care Scale (for Patients) (GPNCS), and the Post Hip Replacement Comfort Scale (PHRCS).

FINDINGS

The mean age of the patients was 65.58 ± 15.10 years. The mean total scores of the patients in GPNCS and PHRCS were 134.61 ± 16.29 and 3.58 ± 0.40, respectively. In the correlation analysis, a statistically significant and positive weak relationship was determined between GPNCS and PHRCS, and as the quality of care during the surgery increases, the postoperative comfort levels increase (r = 0.253, P < .05).

CONCLUSIONS

Ensuring the comfort of patients during the surgery as well as in the pre-, intra- and postoperative period is necessary and important for the quality of care. In addition, since the quality of the care during surgery is effective on the postoperative comfort levels of the patients, quality nursing care is required pre-, intra-, and postoperative periods.

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.

A Randomized Controlled Trial Comparing Flat Times Versus Standard Care in Pediatric Patients Post Cardiac Catheterization

BACKGROUND

Pediatric patients undergoing cardiac catheterization procedures are required to lie flat for 4 hours for femoral venous access and 6 hours for femoral arterial access. Authors of research in adults suggest the flat time for the same access can be safely reduced to 1.5 to 2 hours post procedure. No literature was found that flat times could be safely reduced for pediatric patients.

OBJECTIVE

The purpose of this study was to determine whether decreased flat time for the post-cardiac catheterization pediatric patient would impact the incidence of site bleeding, additional sedation, and the need for a critical care admission.

METHODS

A randomized controlled trial was designed and participants were randomly assigned to experimental or control group. The experimental group reduced flat times to 2 hours for venous and 4 hours for arterial. The control group was standard care of 4 hours for venous and 6 hours for arterial.

RESULTS

A total of 119 participants were enrolled, 60 in the experimental group and 59 in the control group. Results suggest no difference in the incidence of site bleeding (P = .999), additional sedation (P = .653), or need for a critical care admission.

CONCLUSIONS

For pediatric patients undergoing arterial or venous cardiac catheterizations, flat times can safely be reduced without increasing site bleeding, additional sedation, or critical care admissions.

Comparison of the effectiveness of position change for patients with pain and vascular complications after transfemoral coronary angiography: a randomized clinical trial

BACKGROUND

Prolonged immobilization after transfemoral coronary angiography (TFA) may cause pain and vascular complications in patients. This study aimed to evaluate the effectiveness of a change in position to decrease pain and vascular complications for patients after TFA.

METHODS

This randomized clinical trial was conducted in 2020. Purposive sampling of 72 eligible patients undergoing TFA were selected and randomly assigned to either an experimental or control group. Patients in the experimental group (EG) were placed in a supine position for 2 h after angiography, followed by a semi-seated position with the bed angle gradually increased to 45° over 4 h. Patients in the control group (CG) remained in the supine position for 6 h. Vital signs, groin, back and leg pain, hematoma, hemorrhage, and urinary retention were assessed in both groups before, immediately after, and over 6 h after angiography. The Visual Analogue Scale was used to measure pain, the Christensen scale to measure hematoma, counting bloody gases to measure hemorrhage, and patient self-rating to determine urinary retention.

RESULTS

There was no significant difference between EG and CG on score of groin (2.69 ± 1.00 vs. 2.61 ± 1.00, P = 0.74), back (2.19 ± 0.98 vs. 2.47 ± 0.87, P = 0.21), and leg pain (2.14 ± 0.71 vs. 2.50 ± 1.08, P = 0.27) before the TFA. However, from the second hour to the sixth hour after the TFA, the pain in the EG was significantly less than the CG (P < 0.001). So that pain in the groin (1.36 ± 0.48 vs. 3.28 ± 0.81), back (1.25 ± 0.50 vs. 3.81 ± 1.06), and leg (1.44 ± 0.55 vs. 3.28 ± 0.81) for the EG patients was significantly less than the CG in the sixth hour after TFA (P < 0.001). No patients experienced hematoma. No differences were noted between groups in hemorrhage and urinary retention.

CONCLUSIONS

Position change to a semi-seated position in patients after TFA is effective and safe for reduction of pain without increasing vascular complications.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials: IRCT registration number: IRCT20200410047011N1, Registration date: 30/04/2020.

Effects and safety of body positioning on back pain after transcatheter arterial chemoembolization in people with hepatocellular carcinoma: A randomized controlled study

BACKGROUND

People with hepatocellular carcinoma who undergo transcatheter arterial chemoembolization usually experience back pain due to lie supine for at least 4 hours to avoid bleeding and hematoma. Body positioning is an effective and safe method for decreasing back pain in people with transfemoral cardiac catheterization; however, its effects and safety among patients with high bleeding tendency are unknown.

OBJECTIVE

To investigate whether body positioning could decrease back pain without increasing the chance of bleeding after transcatheter arterial chemoembolization.

DESIGN

A single-blind randomized controlled trial (ClinicalTrials.gov No.: NCT03784469).

METHODS

A total of 78 people with liver cancer who had undergone chemoembolization through the femoral artery were enrolled. Each person was randomly assigned to either the control or intervention group (each consisted of 39 participants). The control group received the usual care, remaining flat and lying in a supine position, whereas the intervention group had their positions changed in the second and fourth hour after chemoembolization. Participants' pain level was rated by using numerical rating scale -11 (score from 0 to 10), bleeding was measured by using volume of blood (cc.) in gauze and hematoma size in diameter (cm), and satisfaction was self-rated from 1 to 5. Repeated-measure analysis of variance (ANOVA) was used to compare the difference in pain levels over time within each group and independent t test to compare the mean difference of pain between groups at 5 endpoints, both methods with Bonferroni adjustment. Independent t test, chi-squared test, and Fisher's exact test compared postembolization discomfort, puncture sites bleeding, satisfaction between groups.

RESULTS

Significant changes of pain levels over time in both intervention [F(2.93, 111.20)=7.64, p<.001] and control groups [F(2.66, 101.17)=20.55, p<.001]. The intervention group had a significantly lower mean pain score in the second hour (t = -2.838, p = .006) and fourth hour (t = -4.739, p < .001) when patients turning to the side than did the control group lying supine. Furthermore, patients in the intervention group had significantly higher satisfaction than did those in the control group (t = -2.422, p = .018). No hematoma and significant difference of post-procedural bleeding between groups.

CONCLUSION

Changing patients' body positions in bed after transcatheter arterial chemoembolization is a safe and effective method of decreasing back pain, and increasing patients' satisfaction, without increasing the complications of bleeding and hematoma. Clinicians should change the positions of people with hepatocellular carcinoma 2 hours after they receive transcatheter arterial chemoembolization.

The effectiveness of early position change postcardiac catheterization on patient's outcomes: A randomized controlled trial

BACKGROUND

Nurses play a substantial role in maintaining patient homeostasis postcardiac catheterization. Patients frequently complain of back pain and discomfort as a result of the prolonged bed rest postcatheterization.

AIM

This study aims to evaluate the effectiveness of early position change postcardiac catheterization on reducing patients' pain and discomfort.

SETTINGS

The study was conducted at two cardiac units in a university hospital in Jordan.

PARTICIPANTS

A total of 120 patients were used in the study, 60 patients in each of the two groups-control and intervention.

METHODS

The randomized controlled trial design was used. Data were initially collected 1 hour after sheath removal postcardiac catheterization. After that, the protocol was applied to the interventional group.

RESULTS

Early position change 1 hour after sheath removal after cardiac catheterization was found to be effective in reducing back pain as compared with the control group (P < .001). Also, the study intervention was found to be effective in reducing urinary discomfort (X²  = 50.83, P < .001), and increasing comfort level (X²  = 120, P < .001). However, although participants in the intervention group were less likely to have constipation and hematoma than those in the control group, this outcome was not statistically significant at P > .05.

CONCLUSION

Early position change 1 hour after sheath removal postcardiac catheterization has significant positive effects on patient outcomes by reducing the intensity of back pain and urination problems and increasing patients' comfort level without increasing incidents of vascular complications such as bleeding and hematoma.

The effects of foot reflexology on back pain after coronary angiography: A randomized controlled trial

BACKGROUND AND AIMS

Back pain is among the most common complaints of patients during the first hours after coronary angiography (CA), i.e. when they are restricted to complete bed rest. This study aimed to evaluate the effects of foot reflexology on back pain after CA.

METHODS

This randomized controlled trial was conducted in 2018-2019 on patients hospitalized in the post-angiography unit of Razi hospital, Birjand, Iran. Through convenience sampling, 120 patients were recruited and their demographic characteristics and baseline back pain intensity were assessed immediately after angiography using a demographic questionnaire and a visual analogue scale, respectively. Then, patients were randomly allocated to a control (n = 60) and a reflexology (n = 60) group through block randomization. Patients in the reflexology group received 8-min foot reflexology for each foot (16 min for both feet) while their counterparts in the control group solely received routine post-angiography care services. Back pain assessment was repeated for all participants immediately, two, four, and 6 h after the intervention. Data were analyzed using the SPSS software (v. 16.0).

FINDINGS

Back pain intensity significantly increased after angiography in both groups (P < 0.05). Yet, pain intensity in the reflexology group at all post-intervention measurement time points was significantly less than the control group (P < 0.001).

CONCLUSION

Foot reflexology is effective in significantly reducing back pain after CA.

The efficacy of interventions for back pain in patients after transfemoral coronary angiography: A rapid systematic review

Coronary angiography is a gold standard tool for diagnosis of coronary artery disease. After this test, patients are restricted in bed to prevent vascular complications. Immobilization and bed rest can cause back pain in these patients. The objective of this rapid systematic review is to assess the efficacy of interventions for reducing back pain after transfemoral coronary angiography. All published, peer-reviewed, English-language interventional studies from 1990 to 2017 were identified in a search of Scopus, PubMed, and CINAHL databases. Relevant studies were surveyed with experimental and quasiexperimental designs that assessed the interventions for reducing back pain after coronary angiography. Data were extracted from studies and assessed. Totally 9 studies with 1062 participants which evaluated the interventions for reducing back pain after coronary angiography were included. The findings of these studies suggest that early ambulation and modified positioning were effective to reduce back pain in patients undergoing coronary angiography. The use of early ambulation 2-4 hours after angiography and changing the patients' position along with modified positioning cause a reduction in the back pain of the patients.

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.