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Decreased bed rest post-percutaneous coronary intervention with a 7-French arterial sheath and its effects on
Laura J Wentworth1, Elizabeth L Bechtum1, Jessica G Hoffman1
1Department of Nursing, Mayo Clinic, Rochester, MN, USA.
Insights
Reducing bed rest to 4 hours after 7-French arterial sheath percutaneous coronary intervention is safe. This study found no significant increase in femoral access site complications compared to 6-hour bed rest.
Area of Science:
- Cardiology
- Vascular Access Management
- Patient Recovery Protocols
Background:
- Determining optimal bed rest duration after percutaneous coronary intervention (PCI) with large-bore arterial sheaths (7-French) is crucial.
- Current institutional practices for post-PCI bed rest vary significantly, lacking standardized guidelines for larger sheath sizes.
Purpose of the Study:
- To compare the incidence of femoral access puncture site complications between patients undergoing 4-hour bed rest (case group) and those undergoing 6-hour bed rest (control group) after 7-French arterial sheath PCI.
Main Methods:
- Retrospective study involving 401 patients.
- Data sourced from the National Cardiovascular Data Registry and electronic health records.
- Comparison between a 4-hour bed rest group (152 patients) and a 6-hour bed rest group (249 patients).
Main Results:
- Low complication rates were observed in both groups according to National Cardiovascular Data Registry data.
- Bleeding events within 72 hours: 2% (4-hour group) vs. 1% (6-hour group).
- Access site bleeding (institutional definition): 5% (4-hour group) vs. 4% (6-hour group); Hematoma: 14% (4-hour group) vs. 10% (6-hour group).
Conclusions:
- Decreasing bed rest from 6 to 4 hours for patients with 7-French arterial sheaths post-PCI showed no significant increase in femoral access puncture site complications.
- This finding supports the safety of reduced bed rest duration in patients with larger arterial sheaths after PCI.
Aims And Objectives:
To compare the incidence of femoral access puncture site complications in the control group, who underwent 6 hr of bed rest, with patients in the case group, who underwent 4 hr of bed rest.
Background:
The ideal bed rest length after percutaneous coronary intervention with a 7-French arterial sheath has been investigated by nursing practice. However, in this larger-sheath-size group, best practices have not been determined, and bed rest time continues to vary markedly among institutions.
Design:
Retrospective study.
Methods:
Data were retrieved from the National Cardiovascular Data Registry and electronic health records in this retrospective study. Sample size was 401 patients: 152 case patients with 4-hr bed rest and 249 controls with 6-hr bed rest. Case group data were obtained from 20 May 2013-31 December 2014; and control group data, 15 June 2011-20 May 2013.
Results:
National Cardiovascular Data Registry event rates were generally low in both groups: Only three patients in each group had a bleeding event within 72 hr (2% vs. 1%) and no patient and only two controls had arteriovenous fistula (0% vs. 1%). Complications documented in the electronic health records with institutional femoral access puncture site complication definitions identified bleeding at the access site in eight case patients (5%) and nine controls (4%). Haematoma at the access site occurred in 21 case patients (14%) and 25 controls (10%).
Conclusions:
The practice change of decreasing bed rest from 6-4 hr for patients with 7-French arterial sheaths post-percutaneous coronary intervention was associated with no significant change in femoral access puncture site complications in either National Cardiovascular Data Registry data or institutional electronic health records data.
Relevance To Clinical Practice:
This introduces expanded evidence of safety in decreasing bed rest length in larger (7-French) arterial sheaths post-percutaneous coronary intervention.
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