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Reducing time in bed after percutaneous transluminal coronary angioplasty (TIBS III)
A W Keeling1, C A Fisher, K H Haugh
1University of Virginia School of Nursing, Charlottesville, USA.
Insights
Patients can now rest for 4 hours after percutaneous transluminal coronary angioplasty (PTCA) with femoral artery approach, significantly reducing bed rest time. This change ensures patient safety, with minimal bleeding complications observed in recent studies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access Management
Background:
- Investigating optimal post-procedure care following femoral artery interventions.
- Evaluating the necessity of prolonged bed rest after coronary arteriography and percutaneous transluminal coronary angioplasty (PTCA).
Purpose of the Study:
- To determine the safety and efficacy of a 4-hour bed rest period post-sheath removal in patients undergoing PTCA via femoral artery approach.
- To compare bleeding incidence between 4-hour and 6-hour bed rest protocols.
Main Methods:
- Prospective, experimental-control group design with randomization.
- Comparison of bleeding rates between patients assigned to 4-hour versus 6-hour bed rest.
- Data collection focused on the experimental group (4-hour bed rest) due to healthcare environment changes.
Main Results:
- In the 4-hour bed rest group (n=51), 98% experienced no bleeding from the femoral artery access site.
- Mean time in bed was 4.1 hours; mean length of stay was 1.4 days.
- One patient experienced bleeding, linked to multiple procedures and elevated activated clotting time.
Conclusions:
- The University of Virginia Medical Center has reduced required bed rest time to 4 hours post-PTCA, aligning with cardiac catheterization protocols.
- A 4-hour bed rest period is deemed safe and effective for patients undergoing PTCA via femoral artery approach.
- Patient discomfort remains an area for improvement in post-procedure care.
Background:
This study is the third in a series of investigations on the requisite length of time that patients should be restricted to bed after coronary arteriography or percutaneous transluminal coronary angioplasty using a femoral artery approach.
Methods:
A prospective, experimental-control group design with randomization was used initially to compare the incidence of bleeding between patients who remained in bed for 4 hours and patients who remained in bed for 6 hours after sheath removal following percutaneous transluminal coronary angioplasty.
Results:
Rapid changes in the healthcare environment led to nurses collecting complete data sets for the experimental group only. The experimental group (n = 51) was 73% male and 27% female; mean age was 57 years (SD = 11.4 years). Mean time in bed was 4.1 hours (SD = 0.27 hours). Most patients (98%) did not bleed from the femoral artery access site after remaining in bed for 4 hours following sheath removal. Ninety-two percent of patients required analgesics while in bed. Mean length of stay after the angioplasty was 1.4 days (SD = 0.79 days). Bleeding occurred in one subject and was related to multiple invasive procedures and an activated clotting time of greater than 200 seconds.
Conclusions:
Requisite time in bed after percutaneous transluminal coronary angioplasty has been reduced to 4 hours at the University of Virginia Medical Center, the same time required for patients undergoing cardiac catheterization. Discomfort after the procedure remains to be addressed.