Elsevier

Heart & Lung

Volume 30, Issue 2, March–April 2001, Pages 138-145
Heart & Lung

Issues in Cardiovascular Care
Coronary angiography observations: Evidence-based or ritualistic practice?*,**

https://doi.org/10.1067/mhl.2001.114192Get rights and content

Abstract

Objective: The purposes of this study were to describe the incidence and occurrence of femoral artery bleeding during the first 6 hours after coronary angiography and to determine whether there is a relationship between current postangiogram observation protocols and the detection of complications. Design: This was a prospective descriptive study. Setting: The study was conducted in 3 university hospitals in Melbourne, Australia. Patients: Subjects included 55 patients representing the complication rate of 1075 patients, mean age 61 years (SD, 12), 69% male. Results: About 5.1% of patients had 1 or more incidents of bleeding requiring manual compression. In 4.2% of patients, bleeding occurred within 6 hours of angiography. Bleeding occurred a median of 2.02 hours (Q1 = 45 minutes, Q3 = 4.31 hours) after angiography. Patients without pressure bandaging bled a median of 1.32 hours (Q1 = 36.50 minutes, Q3 = 2.59 hours) after angiography. Patients with pressure bandaging bled a median of 4.75 hours (Q1 = 2.25 hours, Q3 = 7.28 hours) after angiography. In 40.6% of cases, bleeding was detected through the patient’s call for assistance, and in 59.4% of cases nurses noted bleeding while checking the puncture site. Postcatheter observations were recorded 23.70 (SD, 14.60) minutes before the bleeding incident. There were no significant changes in vital signs, systolic blood pressure (P >.05), diastolic blood pressure (P >.05), or pulse (P >.05) before or during a bleeding episode. All were within normal parameters. No neurovascular assessment anomalies were detected. Conclusion: The use of pressure bandaging has a significant effect on the incidence and pattern of bleeding. Routine vital sign measurement has no relevance in detecting local complications after angiography. The most significant complication is bleeding that requires manual compression. Detection is through frequent puncture site observation and patient recognition and communication. (Heart Lung® 2001;30:138-45.)

Section snippets

Methods

This article reports the findings of a study conducted in conjunction with a multicenter randomized trial to detect the effect of compression bandaging on complications and comfort in patients undergoing coronary angiography.10 The study reported here examined specific incidents of femoral artery complications in terms of vital signs immediately before and during femoral hemorrhage, time since previous assessment, and how the complication was detected.

Patient randomization and characteristics

During a 6-month period, 1075 patients undergoing coronary angiography were enrolled in the randomization study; 519 patients were randomized to the pressure-bandage group and 556 to the no-bandage group. This number represents 53.7% of all patients admitted for coronary angiography during this time.

Complications

The characteristics, incidence, time, and extent of local complications in relation to the 2 treatment groups are described in detail in the article by Botti et al.10 The results to be discussed in

Discussion

The general aim of this study was to gain a better understanding of vascular complications after coronary angiography and to determine the efficacy of current assessment protocols in the early detection of these complications. Conducting a randomization study that tested a therapeutic intervention not only met the general aim of the project but also provided a unique opportunity to evaluate the effect of this intervention on the patient outcomes of interest. The use of compression bandaging

Acknowledgements

We are grateful to all of the nurses who participated in the data collection, without whom it would not have been possible. Thank you, also, to Jo McTaggart, Elizabeth Reid, and Heather MacFarlane for their substantial contribution in coordinating this project in their centers.

References (25)

  • G Steffenino et al.

    Ambulation three hours after elective cardiac catheterization through the femoral artery

    Heart

    (1996)
  • P Montes

    Managing outpatient cardiac catheterization

    Am J Nurs

    (1997)
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      The study found that 5.1% of 1,075 patients (N = 55) experienced a recurrent bleed despite controlling for other variables, such as sheath size, length of pressure, and puncture site (Botti et al., 2001). The bleedings had occurred with a median of 2.02 hr after angiography (Botti et al., 2001). Therefore, it has been a long tradition to use pressure dressing to prevent local vascular complications among patients who have undergone femoral artery puncture (Botti, Williamson, Steen, McTaggart, & Reid, 1998).

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      Even though the outcomes of arterial access closure devices are improving, a 2.5% failure rate has been reported.67 A comprehensive approach to observations (local puncture site assessment, limb and systemic observations, and patient-reported data, i.e. pain, sensation, and orientation) is recommended as vital signs alone have not been shown to provide diagnostic clues to localised vascular complications such as haematoma, ecchymosis or bleeding.63 Bleeding during PCI has been found to have a greater impact on mortality than was previously thought.27

    • Routine blood pressure measurements do not predict adverse events in hospitalized patients

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      Even when blood pressure differences of at least 20 mm Hg were considered, the findings were identical. The results of the present study agree with previous studies in selected patients.9-11 However, these studies assessed the value of blood pressure measurement for the management of specific admission diagnoses.

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    *

    Supported by a grant from La Trobe University, Melbourne, Australia.

    **

    Reprint requests: Mari Botti, BA, RN, MRCNA, School of Nursing, Deakin University, 221 Burwood Hwy, Burwood, Victoria 3125, Australia.

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