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Miranda da Costa N, Valéria da Silva E, Barros LM, Miyahara Kobayashi R. Construção e validação das competências profissionais do enfermeiro atuante em hemodinâmica. REME: REVISTA MINEIRA DE ENFERMAGEM 2023. [DOI: 10.35699/2316-9389.2023.40259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
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.
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ZENCIRCI E, ESEN ZENCIRCI A, DEGIRMENCIOGLU A. A randomized trial of flow-mediated dilation to prevent radial artery spasm during transradial approach. Minerva Cardiol Angiol 2022; 70:563-571. [DOI: 10.23736/s2724-5683.20.05463-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shin ES, Kim MH. [The Effects of Hand Massage in Patients Who Underwent Transradial Percutaneous Coronary Intervention]. J Korean Acad Nurs 2018; 48:465-474. [PMID: 30206197 DOI: 10.4040/jkan.2018.48.4.465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 08/06/2018] [Accepted: 08/06/2018] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to determine the effect of hand massage in patients who underwent transradial percutaneous coronary intervention. METHODS This was a quasi-experimental study with a nonequivalent control group and non-synchronized design. The study included 30 patients in the experimental group and 30 in the control group. Hand massage was performed 2 times for 5 minutes each in the experimental group and the control group only received usual nursing interventions. Pain, level of discomfort, and vital signs were defined as key outcome measures, and the data were analyzed using the chi-square test, an independent t-test, Mann-Whitney U test, repeated-measures analysis of variance, and Friedman test. RESULTS Significant differences were observed between the 2 groups in the pain score (F=7.91, p=.003), discomfort score (F=18.15, p<.001), pulse (F=12.92, p<.001), and respiration rate (χ²=19.35, p<.001). CONCLUSION Hand massage can be a helpful nursing intervention for transradial percutaneous coronary intervention by reducing pain and discomfort to a considerable degree.
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Affiliation(s)
- Eun Sil Shin
- Coronary Care Unit, Dong-A University Hospital, Busan, Korea
| | - Myung Hee Kim
- College of Nursing, Pusan National University, Yangsan, Korea.
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Su SF, Chang MY, Wu MS, Liao YC. Safety and efficacy of using vascular closure devices for hemostasis on sheath removal after a transfemoral artery percutaneous coronary intervention. Jpn J Nurs Sci 2018; 16:172-183. [PMID: 30044037 DOI: 10.1111/jjns.12221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/18/2018] [Accepted: 05/22/2018] [Indexed: 11/26/2022]
Abstract
AIM To determine the efficacy of vascular closure devices (VCDs) for hemostasis following transfemoral percutaneous coronary interventions (PCIs). METHODS This two-group pre-post-test observational study with purposive sampling enrolled 73 patients between January, 2014 and February, 2015. The patients were allocated to either the intervention (vascular closure devices group, n = 34) or the control group (manual compression [MC] group, n = 39). Questionnaires were used to assess their demographic and clinical characteristics, vascular complications, visual analogue scale score for pain, and discomfort levels. Pain and discomfort were measured before and after the PCI. RESULTS Vascular complications were observed in 15 (44.1%) VCD patients and 13 (33.3%) MC patients, with no significant between-group difference. However, the VCD patients had a higher relative risk of bruising, hematomas, and need for further treatment. After the PCI, the pain scores and discomfort levels increased significantly in both groups, but the VCD patients had more successful hemostasis, less pain, and less physical and psychological discomfort (lower-limb numbness, shoulder pain, restlessness, and worrying about walking ability, being unable to lift heavy objects in the future, and taking time off from work). CONCLUSION The VCDs seem to be superior to the MCs, providing more successful hemostasis, less pain and discomfort, and earlier ambulation after a transfemoral PCI. These findings aid clinical nurses in understanding the risk of vascular complications, discomfort, and pain that are associated with VCD use for improving the quality of clinical care and help clinicians in determining the appropriate hemostatic method for patients undergoing a transfemoral PCI, particularly in the Chinese population.
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Affiliation(s)
- Shu-Fen Su
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Mei-Yu Chang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Meng-Shan Wu
- Department of Nursing, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
| | - Ying-Chin Liao
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Fuxing Township, Taiwan
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Khoo CW, Holroyd EW, Butler R, Nolan J, Mamas MA. Transradial percutaneous coronary intervention in high-risk patients. Interv Cardiol 2015. [DOI: 10.2217/ica.15.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Taylor M, Capers Q, Patel D, Mehta NK. Rebirth of left radial artery access: could this be the 'right' radial artery? Expert Rev Cardiovasc Ther 2015; 13:637-41. [PMID: 26000561 DOI: 10.1586/14779072.2015.1043271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiac catheterization has several risks, notably which include bleeding, stroke and death. The transradial (TR) approach to catheterization is associated with a lower bleeding risk. The right radial approach is the default method in most laboratories and the left radial artery (LRA) serves as the bail-out approach. This article discusses the advantages and disadvantages of transfemoral and TR access routes. The authors envisage an increased adoption of the LRA approach, due to the anatomical superiority and ease of catheter engagement afforded by this approach. The authors discuss ways to increase operator ease for LRA in the laboratory and propose a novel way to improve LRA work-flow.
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Affiliation(s)
- Montoya Taylor
- Division of Cardiovascular Medicine, The Ohio State University, 473 W 12th Avenue, Columbus, OH 43221, USA
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Aydin A, Gurol T, Soylu O, Dagdeviren B. Early ambulatory discharge is safe and feasible after transradial coronary interventions. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 3:60-63. [PMID: 29450172 PMCID: PMC5801437 DOI: 10.1016/j.ijchv.2014.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 03/08/2014] [Indexed: 06/08/2023]
Abstract
BACKGROUND At present, there are no definite criteria for selecting patients eligible for same-day discharge after percutaneous coronary interventions (PCI). With rapid ambulation and reduced vascular complication rates, transradial PCI have many features that favorably reduce costs and hospital stay. This study aimed to demonstrate the possibility of early ambulatory discharge following transradial percutaneous coronary interventions. METHODS 254 consecutive patients undergoing transradial PCI (elective, urgent, and emergent) at our center was observed during hospital stay. Patient demographics, angiographic characteristics, post-procedural complications, and timing of these post-procedural events were recorded. RESULTS A total of 336 lesions were treated among 299 vessels with 277 stents. One hundred fifty-two (45.2%) lesions were Type C. There were 26 chronic total occlusions (CTO). One hundred fifty-five (61%) patients were discharged on the same day after the procedure. 24 complications (12.6%) occurred and were divided into three groups according to occurrence time. 13 (54.2%) occurred within the first 2 h and 11 (45.8%) occurred after the 24-hour period. No complications were observed between the 2nd and 24th hours. CONCLUSIONS Same-day discharge with a 2-hour observation period is safe and feasible after successful transradial PCI in appropriate patients. Although a minor number of complications occurred, these did not occur between the 2nd and 24th hours. Same-day discharge after successful transradial PCI could be an alternative for better utilization of resources.
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Affiliation(s)
- Alper Aydin
- Corresponding author at: Bahcesehir University School of Medicine, Department of Cardiology, Goztepe Medical Park Hastanesi, 23 Nisan Sok No 17 Goztepe Istanbul, Turkey. Tel.: + 90 542 5855519Corresponding author at: Bahcesehir University School of MedicineDepartment of CardiologyGoztepe Medical Park Hastanesi23 Nisan Sok No 17, GoztepeTel.: + 90 542 5855519IstanbulTurkey
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Komócsi A, Aradi D, Kehl D, Ungi I, Thury A, Pintér T, Di Nicolantonio JJ, Tornyos A, Vorobcsuk A. Meta-analysis of randomized trials on access site selection for percutaneous coronary intervention in ST-segment elevation myocardial infarction. Arch Med Sci 2014; 10:203-12. [PMID: 24904651 PMCID: PMC4042040 DOI: 10.5114/aoms.2014.42570] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 05/23/2013] [Accepted: 06/04/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Superior outcomes with transradial (TRPCI) versus transfemoral coronary intervention (TFPCI) in the setting of acute ST-segment elevation myocardial infarction (STEMI) have been suggested by earlier studies. However, this effect was not evident in randomized controlled trials (RCTs), suggesting a possible allocation bias in observational studies. Since important studies with heterogeneous results regarding mortality have been published recently, we aimed to perform an updated review and meta-analysis on the safety and efficacy of TRPCI compared to TFPCI in the setting of STEMI. MATERIAL AND METHODS Electronic databases were searched for relevant studies from January 1993 to November 2012. Outcome parameters of RCTs were pooled with the DerSimonian-Laird random-effects model. RESULTS Twelve RCTs involving 5,124 patients were identified. According to the pooled analysis, TRPCI was associated with a significant reduction in major bleeding (odds ratio (OR): 0.52 (95% confidence interval (CI) 0.38-0.71, p < 0.0001)). The risk of mortality and major adverse events was significantly lower after TRPCI (OR = 0.58 (95% CI: 0.43-0.79), p = 0.0005 and OR = 0.67 (95% CI: 0.52-0.86), p = 0.002 respectively). CONCLUSIONS Robust data from randomized clinical studies indicate that TRPCI reduces both ischemic and bleeding complications in STEMI. These findings support the preferential use of radial access for primary PCI.
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Affiliation(s)
| | | | - Dániel Kehl
- Department of Statistics and Econometrics, Faculty of Business and Economics, University of Pécs, Hungary
| | - Imre Ungi
- Invasive Cardiology Unit, Cardiology Center, University of Szeged, Hungary
| | - Attila Thury
- Invasive Cardiology Unit, Cardiology Center, University of Szeged, Hungary
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Access site complications and puncture site pain following transradial coronary procedures: A correlational study. Int J Nurs Stud 2013; 50:1304-13. [DOI: 10.1016/j.ijnurstu.2012.12.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 11/24/2012] [Accepted: 12/25/2012] [Indexed: 11/18/2022]
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Hamon M, Pristipino C, Di Mario C, Nolan J, Ludwig J, Tubaro M, Sabate M, Mauri-Ferré J, Huber K, Niemelä K, Haude M, Wijns W, Dudek D, Fajadet J, Kiemeneij F. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care** and Thrombosis of the European Society of Cardiology. EUROINTERVENTION 2013; 8:1242-51. [PMID: 23354100 DOI: 10.4244/eijv8i11a192] [Citation(s) in RCA: 273] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Radial access use has been growing steadily but, despite encouraging results, still varies greatly among operators, hospitals, countries and continents. Twenty years from its introduction, it was felt that the time had come to develop a common evidence-based view on the technical, clinical and organisational implications of using the radial approach for coronary angiography and interventions. The European Association of Percutaneous Cardiovascular Interventions (EAPCI) has, therefore, appointed a core group of European and non-European experts, including pioneers of radial angioplasty and operators with different practices in vascular access supported by experts nominated by the Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology (ESC). Their goal was to define the role of the radial approach in modern interventional practice and give advice on technique, training needs, and optimal clinical indications.
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Affiliation(s)
- Martial Hamon
- Recherche Clinique, Bureau 364, Centre Hospitalier Universitaire de Caen, Avenue Côte de Nacre, 14033 Caen, Normandie, France.
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Qin X, Xiong W, Wang L, Guan E, Lu C. Clinical investigation of transradial access for emergent percutaneous coronary intervention in patients with acute myocardial infarction. Clin Interv Aging 2013; 8:1139-42. [PMID: 24039410 PMCID: PMC3769410 DOI: 10.2147/cia.s50939] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Use of intensive anticoagulation and antiplatelet therapy in acute myocardial infarction (AMI) potentially increases the risk of bleeding complications during percutaneous coronary intervention via the transfemoral route. Recently, the transradial access has been intensively employed as an alternative means for diagnostic and interventional procedures. A low incidence of vascular access site bleeding complications suggests that the transradial access is a safe alternative to the transfemoral technique in patients with AMI. The safety and efficacy of transradial access for emergent percutaneous coronary intervention in patients with AMI has not been investigated in the People’s Republic of China. Methods We analyzed data from our single-center registry on 596 consecutive patients between October 2003 and October 2010. The patients were retrospectively divided into a transradial group (n = 296) and a transfemoral group (n = 300). A dedicated doctor was appointed to collect the following data: puncture time, coronary angiography time, percutaneous coronary intervention time, X-ray exposure time, duration of hospitalization, and complication rates associated with puncture, such as puncture site bleeding, hematoma, pseudoaneurysm, and major adverse cardiac events. Results There were no significant differences in baseline characteristics and angiographic findings between the two groups. There were also no significant differences in coronary angiography time (8.2 ± 2.4 versus 7.6 ± 2.0 minutes), percutaneous coronary intervention time (30 ± 6.8 versus 29.6 ± 8.1 minutes), or X-ray exposure time (4.6 ± 1.4 versus 4.4 ± 1.3 minutes) between the groups. There were significant differences in puncture time (4.4 ± 1.6 versus 2.4 ± 0.8 minutes) and duration of hospitalization (3.2 ± 1.6 versus 5.4 ± 1.8 days) between the groups (P < 0.001). The complication rate using transradial access was 2.03% (6/296) versus 6.0% (18/300) using transfemoral access (P < 0.0001). Conclusion Transradial access for emergent percutaneous coronary intervention is safe and effective in patients with AMI, and it is suggested that this route could be used more widely in these patients.
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Affiliation(s)
- Xuguang Qin
- Department of Cardiology, First Affiliated hospital of Tsinghua University, Beijing, People's Republic of China
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Amoroso G. Transradial approach for percutaneous coronary interventions: the future is now. Interv Cardiol 2013. [DOI: 10.2217/ica.13.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Yan Z, Zhou Y, Zhao Y, Zhou Z, Yang S, Wang Z. Impact of Transradial Coronary Procedures on Radial Artery Function. Angiology 2013; 65:104-7. [DOI: 10.1177/0003319713479650] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated the impact of transradial coronary procedures on the vasodilatory function of the radial artery. A total of 65 patients who underwent transradial coronary procedures were enrolled. All patients were examined with B-mode high-resolution ultrasound. Radial artery baseline diameter and response to flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) were measured in the right radial artery. The FMD of the right radial artery was 11.5%, 4.1%, and 0.7%, respectively, before the procedures, 1 day, and 3 months after the procedures ( P < .05 at 1 day, P < .01 at 3 months). The NMD of the right radial artery was 17.6%, 5.4%, and 6.3%, respectively, before the procedures, 1 day, and 3 months after the procedures ( P < .05 at 1 day, P < .05 at 3 months). Transradial coronary procedures decrease radial artery FMD and NMD resulting in immediate and persistent blunting of vasodilatory function.
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Affiliation(s)
- Zhenxian Yan
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Yingxin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Zhiming Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Shiwei Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Zhijian Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing, China
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Transitioning to transradials: a collaborative process in the cardiac catheterization laboratory. Dimens Crit Care Nurs 2012; 32:1-5. [PMID: 23222218 DOI: 10.1097/dcc.0b013e3182767e59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
As transradial approaches to cardiac catheterizations and percutaneous coronary interventions steadily rise in the United States, we reviewed evidence-based studies to compare the radial and femoral approaches to cardiac catheterization. The purpose of this article was to provide an overview of transradial and femoral approaches for cardiac catheterizations and percutaneous coronary interventions, preparation for the procedure, and nursing management of these patients. The strategies used to develop the transition process are also discussed.
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Malaiapan Y, Leung M, Ahmar W, Hutchison AW, Prasad S, Katticaran T, Cameron JD, Harper RW, Meredith IT. Guideline recommended door-to-balloon time can be achieved in transradial primary PCI--the usefulness of a dedicated radial guide catheter. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2012; 14:27-31. [PMID: 23228445 DOI: 10.1016/j.carrev.2012.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 10/18/2012] [Accepted: 10/30/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radial access for primary percutaneous coronary intervention (PPCI) is well established in terms of safety and efficacy. However, there are limited data on the impact of the use of a single dedicated radial guide catheter in primary PCI using radial access. AIMS To determine the overall cardiac catheterisation laboratory to balloon time (CCL2BT) and door to balloon (D2BT) time in transradial PPCI. To determine the impact of a single dedicated radial guide catheter on CCLD2BT and D2BT in transradial PPCI compared to conventional transfemoral PPCI. METHODS The procedural and clinical outcomes of consecutive patients who had transradial primary PCI between 2005 and 2009 were included in this study and compared with a matched cohort who underwent transfemoral primary PCI. RESULTS Overall D2BT and inpatient MACE were similar between the radial (n=53) and femoral (n=53) groups (85 and 82 min, P=0.889; 0% and 1.8% P=0.317 respectively). An increase in the CCL2BT and procedural times was noted in the radial compared to the femoral group (34 min versus 29 min P=0.028; 15.8 min versus 11.6 min P=0.001). When a single radial guide catheter was used for the entire procedure, there was no difference in CCL2BT, D2BT and procedural times between the radial and femoral groups (31 min versus 29 min P=0.599; 74 min versus 82 min P=0.418; 50 min versus 47 min P=0.086). CONCLUSION The radial approach is safe and results in guideline recommended D2BT in STEMI. The use of a dedicated radial guide catheter reduces treatment time, demonstrating equivalent times to a femoral approach.
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Affiliation(s)
- Yuvaraj Malaiapan
- Monash Cardiovascular Research Centre, MonashHEART, Southern Health & Department of Medicine (MMC), Monash University, Melbourne, Australia.
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Summaria F, Lucci V, Mustilli M. Transulnar sheathless percutaneous coronary intervention during bivalirudin infusion in high-risk elderly female with non-ST segment elevation myocardial infarction. Heart Int 2012. [PMID: 23185677 PMCID: PMC3504302 DOI: 10.4081/hi.2012.e10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Due to the ageing population and raised life expectancy, elderly patients are increasingly referred for percutaneous coronary intervention (PCI) during acute coronary syndromes (ACS). Bleeding complications are not infrequent during ACS, occurring in 2-5% of patients with prognostic and economic consequences. In particular, periprocedural bleeding and vascular complications are associated with worse clinical outcome, prolonged hospital stay and increased short- and long-term mortality, especially in elderly patients with acute coronary syndromes. We report the case of an 83-year old female referred to our hospital because of non-ST segment elevation myocardial infarction with high bleeding risk and unsuitable radial artery undergoing tran-sulnar sheathless PCI during bivalirudin infusion. The clinical, technical, pharmacological and prognostic implications are discussed.
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HU FENGHUAN, YANG YUEJIN, QIAO SHUBIN, XU BO, LIU HAIBO, WU YONGJIAN, CHEN JUE, YOU SHIJIE, CHEN JILIN, GAO RUNLIN. Comparison Between Radial and Femoral Approach for Percutaneous Coronary Intervention in Patients Aged 80 Years or Older. J Interv Cardiol 2012; 25:513-7. [DOI: 10.1111/j.1540-8183.2012.00732.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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MOON KEONWOONG, KIM JIHOON, KIM JUYOUN, JUNG MIHYANG, KIM GEEHEE, YOO KIDONG, KIM CHULMIN. Reducing Needle-To-Balloon Time by Using a Single Guiding Catheter during Transradial Primary Coronary Intervention. J Interv Cardiol 2012; 25:330-6. [DOI: 10.1111/j.1540-8183.2011.00717.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Moon KW, Kim JH, Yoo KD, Oh SS, Kim DB, Kim CM. Evaluation of Radial Artery Atherosclerosis by Intravascular Ultrasound. Angiology 2012; 64:73-9. [DOI: 10.1177/0003319712437030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Keon-Woong Moon
- Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Ji-Hoon Kim
- Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Ki-Dong Yoo
- Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Su-Sung Oh
- Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Dong-Bin Kim
- Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
| | - Chul-Min Kim
- Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, South Korea
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Summaria F, Romagnoli E, Preziosi P. Percutaneous antegrade transarterial treatment of iatrogenic radial arteriovenous fistula. J Cardiovasc Med (Hagerstown) 2012; 13:50-2. [DOI: 10.2459/jcm.0b013e3283461126] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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SCIAHBASI ALESSANDRO, MANCONE MASSIMO, CORTESE BERNARDO, PENDENZA GIANLUCA, ROMAGNOLI ENRICO, FISCHETTI DIONIGI, TOMASSINI FRANCESCO, SARDELLA GENNARO, LIOY ERNESTO. Transradial Percutaneous Coronary Interventions Using Sheathless Guiding Catheters: A Multicenter Registry. J Interv Cardiol 2011; 24:407-12. [DOI: 10.1111/j.1540-8183.2011.00663.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Caputo RP, Tremmel JA, Rao S, Gilchrist IC, Pyne C, Pancholy S, Frasier D, Gulati R, Skelding K, Bertrand O, Patel T. Transradial arterial access for coronary and peripheral procedures: Executive summary by the transradial committee of the SCAI. Catheter Cardiovasc Interv 2011; 78:823-39. [PMID: 21544927 DOI: 10.1002/ccd.23052] [Citation(s) in RCA: 221] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 02/13/2011] [Indexed: 01/21/2023]
MESH Headings
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/methods
- Angioplasty, Balloon, Coronary/standards
- Cardiac Catheterization/adverse effects
- Cardiac Catheterization/methods
- Cardiac Catheterization/standards
- Cardiovascular Diseases/diagnostic imaging
- Cardiovascular Diseases/therapy
- Catheterization, Peripheral/adverse effects
- Catheterization, Peripheral/methods
- Catheterization, Peripheral/standards
- Clinical Competence
- Coronary Angiography/adverse effects
- Coronary Angiography/methods
- Coronary Angiography/standards
- Credentialing
- Endovascular Procedures/adverse effects
- Endovascular Procedures/methods
- Endovascular Procedures/standards
- Humans
- Patient Selection
- Radial Artery
- Risk Assessment
- Risk Factors
- Societies, Medical
- Treatment Outcome
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Affiliation(s)
- Ronald P Caputo
- St. Joseph's Hospital, S.U.N.Y. Upstate Medical School, Syracuse, New York 13203, USA.
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Best PJM, Skelding KA, Mehran R, Chieffo A, Kunadian V, Madan M, Mikhail GW, Mauri F, Takahashi S, Honye J, Hernández-Antolín R, Weiner BH. SCAI consensus document on occupational radiation exposure to the pregnant cardiologist and technical personnel. Heart Lung Circ 2011; 20:83-90. [PMID: 21241961 DOI: 10.1016/j.hlc.2010.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Concerns regarding radiation exposure and its effects during pregnancy are often quoted as an important barrier preventing many women from pursuing a career in Interventional Cardiology. Finding the true risk of radiation exposure from performing cardiac catheterisation procedures can be challenging and guidelines for pregnancy exposure have been inadequate. The Women in Innovations group of Cardiologists with endorsement of the Society for Cardiovascular Angiography and Interventions aim to provide guidance in this publication by describing the risk of radiation exposure to pregnant physicians and cardiac catheterisation personnel, to educate on appropriate radiation monitoring and to encourage mechanisms to reduce radiation exposure. Current data do not suggest a significant increased risk to the foetus of pregnant women in the cardiac catheterisation laboratory and thus do not justify precluding pregnant physicians from performing procedures in the cardiac catheterisation laboratory. However, radiation exposure amongst pregnant physicians should be properly monitored and adequate radiation safety measures are still warranted.
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Affiliation(s)
- Patricia J M Best
- Department of Internal Medicine and Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
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Steffenino G, Fabrizi MDB, Baralis G, Tomatis M, Mogna A, Dutto M, Dutto MS, Conte L, Lice G, Cavallo S, Porcedda B. Implementation of radial arterial access for cardiac interventions: a strong case for quality assurance protocols by the nursing staff. J Cardiovasc Med (Hagerstown) 2011; 12:116-21. [PMID: 21135588 DOI: 10.2459/jcm.0b013e328340392c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Radial arterial access is becoming increasingly popular for coronary angiography and angioplasty. The technique is, however, more demanding than femoral arterial access, and hemostasis is not care-free. A quality assurance program was run by our nursing staff, with patient follow-up, to monitor radial arterial access implementation in our laboratory. METHOD In 973 consecutive patients, both a hydrophilic sheath and an inflatable bandage for hemostasis were used. Bandage inflation volume and time were both reduced through subsequent data audit and protocol changes (A = 175 patients; B = 297; C = 501). RESULTS An increase was achieved in the percentage of patients with neither loss of radial pulse nor hematoma of any size (A = 81.3%, B = 90.9%, C = 92.2%, P < 0.001), and no discomfort at all (A = 44.2%, B = 75.1%, C = 89.3%, P < 0.001). Follow-up was available for 965 patients (99%), and in 956, the access site could be re-inspected at least once. There were no vascular complications. Overall, the radial artery pulse was absent at latest follow-up in 0.6% of cases (95% confidence interval 0.21-1.05%). In 460 consecutive patients with complete assessment in protocol C, a palpable arterial pulse was absent in 5% of cases at about 20 h after hemostasis. Barbeau's test was positive in 26.5% of patients (95% confidence interval 22.5-30.6%). They had a significantly lower body weight, a lower systolic blood pressure at hemostasis, and a higher bandage inflation volume; a hematoma of any size and the report of any discomfort were also more frequent. Barbeau's test returned to normal in 30% of them 3-60 days later. CONCLUSION Our nurse-led quality assurance program helped us in reducing minor vascular sequelae and improving patient comfort after radial access. Early occlusion of the radial artery as detected by pulse oxymeter is frequent, often reversible, and may be mostly related to trauma/occlusion of the artery during hemostasis.
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Affiliation(s)
- Giuseppe Steffenino
- Interventional Cardiology Unit, Cardiovascular Department, Santa Croce and Carle Hospital, Italy.
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25
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Rolley JX, Salamonson Y, Wensley C, Dennison CR, Davidson PM. Nursing clinical practice guidelines to improve care for people undergoing percutaneous coronary interventions. Aust Crit Care 2011; 24:18-38. [DOI: 10.1016/j.aucc.2010.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 07/14/2010] [Accepted: 08/03/2010] [Indexed: 11/26/2022] Open
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26
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Best P, Skelding K, Mehran R, Chieffo A, Kunadian V, Madan M, Mikhail G, Mauri F, Takahashi S, Honye J, Hernández-Antolín R, Weiner B. SCAI consensus document on occupational radiation exposure to the pregnant cardiologist and technical personnel. EUROINTERVENTION 2011; 6:866-74. [DOI: 10.4244/eijv6i7a148] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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27
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Abstract
Advances in percutaneous coronary intervention (PCI) and peri-procedural potent antithrombotic treatments during the past decade have dramatically improved the outcomes of ischemic heart disease. The femoral artery is the vascular route used in PCI in most catheterization labs. However, when the femoral artery is used as the approaching vessel, local hemorrhagic complication is not rare in the era of potent antithrombotics. Recent studies have suggested that peri-procedural bleeding complications after PCI are associated with increased short- and long-term morbidity and mortality. On the other hand, there has been growing interest in transradial PCI due to rare complications at the puncture site, patient conveniences, early discharge and shortened hospitalization periods. Furthermore, the indications of transradial PCI are expanding to the complex lesion subsets due to the miniaturization of devices used, improvement of devices and techniques, and accumulated experience with the use of transradial PCI. In this review, we discuss the data of transradial PCI as a potential default route in coronary artery interventions, as well as other issues that may raise concerns with transradial PCI.
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Affiliation(s)
- Jang-Young Kim
- Divison of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
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28
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Best PJM, Skelding KA, Mehran R, Chieffo A, Kunadian V, Madan M, Mikhail GW, Mauri F, Takahashi S, Honye J, Hernández-Antolín R, Weiner BH. SCAI consensus document on occupational radiation exposure to the pregnant cardiologist and technical personnel. Catheter Cardiovasc Interv 2011; 77:232-41. [DOI: 10.1002/ccd.22877] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 10/14/2010] [Indexed: 11/05/2022]
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29
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Prevalence of transradial coronary angiography and intervention in China: Report from the Transradial coronary intervention Registration Investigation in China (TRI-China). Int J Cardiol 2010; 145:246-247. [DOI: 10.1016/j.ijcard.2009.08.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Accepted: 08/20/2009] [Indexed: 11/20/2022]
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30
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Frank JJ, Kamalakannan D, Kodenchery M, Savoy-Moore RT, Rosman H. Retroperitoneal hematoma in patients undergoing cardiac catheterization. J Interv Cardiol 2010; 23:569-74. [PMID: 20796167 DOI: 10.1111/j.1540-8183.2010.00583.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To retrospectively study demographic, clinical and hospital outcomes in patients who developed RPH following cardiac catheterization. METHODS Charts of patients with RPH from cardiac catheterization, between January 1, 2000 and July 30, 2005 were reviewed and compared with two control groups (Grp-I, 90 patients with local groin complications and Grp-II, 98 patients with no bleeding complications). RESULTS 31 cases of RPH (0.13%) were identified with 84% females. Most common presentation was hypotension (87%) and hemoglobin drop (96%). CT scan was the diagnostic modality in 93% cases. The mean body surface area in RPH group (1.77 ± .23) was significantly lower than in control group I (1.93 ± .28) and II (1.98 ± .27). The use of larger sheath size was significantly higher in the RPH group (61.3%) than control groups I (26.7%) and II (21.4%). Left groin access was significantly more in RPH group (16.1%) and control group I (17.8) than control group II (0%). The use of antiplatelets and anticoagulants were significantly higher in the RPH group. 13% of patients with RPH were treated surgically. The average hospital stay was 8.6 days, 4.5 days and 3.5 days and mortality 12.9%, 3.3% and 1% in RPH group, control group I and II respectively. CONCLUSION Our study is the second largest series of RPH following cardiac catheterization and predicts female gender, large sheath size, left groin access and low body surface area as risk factors for RPH.
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Affiliation(s)
- John J Frank
- St. John Hospital and Medical Center and Wayne State University, Detroit, Michigan 48236, USA.
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31
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Pristipino C, Roncella A, Trani C, Nazzaro M, Berni A, Di Sciascio G, Sciahbasi A, Musarò S, Mazzarotto P, Gioffrè G, Speciale G. Identifying factors that predict the choice and success rate of radial artery catheterisation in contemporary real world cardiology practice: a sub-analysis of the PREVAIL study data. EUROINTERVENTION 2010. [DOI: 10.4244/eijv6i2a38] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rao SV, Cohen MG, Kandzari DE, Bertrand OF, Gilchrist IC. The Transradial Approach to Percutaneous Coronary Intervention. J Am Coll Cardiol 2010; 55:2187-95. [DOI: 10.1016/j.jacc.2010.01.039] [Citation(s) in RCA: 196] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Revised: 01/04/2010] [Accepted: 01/05/2010] [Indexed: 10/19/2022]
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Transradial access compared with femoral puncture closure devices in percutaneous coronary procedures. Int J Cardiol 2009; 137:199-205. [DOI: 10.1016/j.ijcard.2008.06.045] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 05/02/2008] [Accepted: 06/01/2008] [Indexed: 11/21/2022]
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Abstract
This article reviews the current technique of coronary angiography, focusing on the choice of arterial access site; navigation from the arterial access site to the ascending thoracic aorta; cannulation of the native coronary arteries in their normal, variant, and anomalous locations; and cannulation of saphenous vein and arterial graft conduits. The authors conclude that, although no didactic training can substitute for the hands-on apprenticeship obtained during general cardiology and interventional cardiology fellowships, the intellectual elements fundamental to coronary angiography outlined here will result in a more efficient, effective, and safe procedure for patients.
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Affiliation(s)
- Ivan P Casserly
- University of Colorado Hospital, Anschutz Medical Campus, Leprino Building, Room #524, 12401 E. 17th Ave., P.O. Box 6511, Aurora, CO 80045, USA.
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Lombardo-Martínez J, Díaz-Bejarano D, Pedrosa-Carrera C, Sánchez-Baños B, Gómez-Santana C, Fernández Álvarez V, González-Díaz JM, González-Rivero D, Valero-López A, Cubero-Gómez JM. Ensayo clínico sobre la compresión radial guiada por la presión arterial media. ENFERMERIA CLINICA 2009; 19:199-205. [DOI: 10.1016/j.enfcli.2009.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 01/26/2009] [Indexed: 10/20/2022]
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Rolley JX, Davidson PM, Salamonson Y, Fernandez R, Dennison CR. Review of nursing care for patients undergoing percutaneous coronary intervention: a patient journey approach. J Clin Nurs 2009; 18:2394-405. [PMID: 19538559 DOI: 10.1111/j.1365-2702.2008.02768.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- John X Rolley
- School of Nursing & Midwifery, College of Health Science, Curtin University of Technology, Level 7, 39 Regent Street, Chippendale, Sydney, NSW, Australia.
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Jabara R, Gadesam R, Pendyala L, Chronos N, Crisco LV, King SB, Chen JP. Ambulatory discharge after transradial coronary intervention: Preliminary US single-center experience (Same-day TransRadial Intervention and Discharge Evaluation, the STRIDE Study). Am Heart J 2008; 156:1141-6. [PMID: 19033010 DOI: 10.1016/j.ahj.2008.07.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 07/19/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although the safety and cost-effectiveness of same-day discharge after uncomplicated transradial percutaneous coronary intervention (TR-PCI) is well established in Europe and Asia, such data are not available for US patients. METHODS All patients who underwent TR-PCI at our high-volume US medical center between 2004 and 2007 were included in this study. The primary end point was in-hospital adverse clinical outcomes between 6 and 24 hours postprocedure. RESULTS A total of 450 patients were included in this study (aged 59 +/- 11 years). Of these, 13% were female, 27% were diabetic, 6% had peripheral vascular disease, and 5% had chronic kidney disease. Procedural indications included stable angina (49%), unstable angina (31%), non-ST elevation myocardial infarction (NSTEMI) (17%), and ST elevation myocardial infarction (STEMI) (3%). All patients received an intra-arterial cocktail of heparin, verapamil, and nitroglycerin, and 13% of patients received glycoprotein IIb/IIIa inhibitors. Seven percent of patients had 3-vessel disease, 3% had bypass grafts stenoses, and 20% had class B(2)/C lesions. Procedural success rate was 96%. A total of 24 (5.3%) postprocedural complications were observed; however, none occurred between hours 6 to 24, the time differential between same-day and next-day discharge. Thirteen patients (2.9%) experienced significant complications within the first 6 hours (MI, urgent repeat revascularization, and ventricular tachycardia). Eleven (2.4%) spontaneously resolved minor access complications developed. There were 12 same-day discharges according to the operators' discretion; none required readmission. CONCLUSIONS Although a low incidence of complications did occur, none would have been impacted by same-day discharge. Those observed before 6 hours would have prevented early discharge, and those occurring after 24 hours would have been unaffected by routine next-day discharge. This observational study demonstrated the safety and feasibility for a prospective evaluation of ambulatory TR-PCI in an American practice setting.
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Chen J, Gao L, Yao M, Chen J. Arritmias ventriculares durante angiografía coronaria diagnóstica con catéter universal de 4 o 5 French. Rev Esp Cardiol 2008. [DOI: 10.1157/13126050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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