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Wound management and restrictive arm movement following cardiac device implantation - evidence for practice?
Katrine Bavnbek1, Syed Y Ahsan, Julie Sanders
1The Heart Hospital, University College London Hospitals, UK. katrine.bavnbek@uclh.nhs.uk
Insights
Postoperative care for cardiac device implantation lacks evidence-based guidelines. Early arm movement is safe, and wound care may follow general guidelines, but further research is needed.
Area of Science:
- Cardiology
- Medical Device Technology
- Nursing Research
Background:
- Cardiac device implantation rates are increasing, leading to more potential complications like wound infection and lead displacement.
- Current postoperative care lacks standardized national/international guidelines, creating controversy in wound management and arm movement protocols.
Purpose of the Study:
- To review existing evidence on postoperative care for cardiac device implantation.
- To identify gaps in current practice and inform future research directions.
Main Methods:
- Comprehensive electronic literature search across major databases (EMBASE, CINAHL, PubMed, Cochrane, etc.).
- Focused on identifying evidence related to wound management and lead displacement following cardiac device implantation.
Main Results:
- Established practices in some areas are tradition-based rather than evidence-based.
- National Institute for Health and Clinical Excellence (NICE) guidelines suggest postoperative wound covering for 48 hours, followed by showering.
- Early mobilization and full range of arm movements post-implantation appear safe, warranting further validation.
Conclusions:
- Gaps in evidence highlight a need for more research, particularly on adapting general wound care guidelines for cardiac device patients.
- Nursing education requires enhanced focus on critical appraisal and research generation to improve patient outcomes.
- Nurses are crucial in identifying and addressing research questions to enhance patient care and outcomes.
Background:
The rate of cardiac device implantation has risen significantly secondary to an increase in the number of indications. Wound infection and lead displacement are two common and potentially life-threatening complications. No national/international guidelines address postoperative care and controversy exists regarding wound management and arm movement following cardiac device implantation.
Aims:
We aimed to explore and review the evidence behind current practice but found that certain aspects of established practice.
Methods:
An electronic search of the databases EMBASE, British Nursing Index, CINAHL, Cochrane and PubMed to identify evidence regarding wound management and lead displacement.
Findings:
We found that certain aspects of established practice are based on tradition rather than evidence. Recent guidelines on wound management published by The National Institute for Health and Clinical Excellence in the UK recommend covering the wound postoperatively for 48 h with a low-adherent transparent dressing and letting patients shower thereafter. Since specific guidelines for cardiac device patients are lacking, we suggest that further research address whether or not the NICE guidelines can be extrapolated to this area. Studies showed that early mobilisation and allowing a full range of arm movements following device implantation is safe. Further research must validate these findings.
Conclusion:
We discuss the reasons behind these gaps in the evidence base and support the idea that nursing education has not placed enough emphasis on how to critically appraise research. This accounts for the very small proportion of nurses that get involved in conducting research and generating guidelines. Additionally, we argue that nurses can play a key role in identifying and addressing research questions that lead to improved patient outcome. Thus, we support proposals to enhance nurses' opportunities to pursue academic careers to achieve adequate research skills.
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