Nursing interventions to decrease bleeding at the femoral access site after percutaneous coronary intervention

2000 ◽  
Vol 9 (1) ◽  
pp. 79-79
Author(s):  
RA Krouscoup
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Nursing Interventions ◽  
Access Site ◽  
Femoral Access ◽  
Percutaneous Coronary

Nursing interventions to decrease bleeding at the femoral access site after percutaneous coronary intervention. SANDBAG Nursing Coordinators. Standards of Angioplasty Nursing Techniques to Diminish Bleeding Around the Groin

1999 ◽  
Vol 8 (5) ◽  
pp. 303-313 ◽  
Author(s):  
NB Juran ◽  
CL Rouse ◽  
DD Smith ◽  
MA O'Brien ◽  
SA DeLuca ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Standards Of Care ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Nursing Interventions ◽  
Access Site ◽  
Femoral Access ◽  
Percutaneous Coronary ◽  
Coronary Procedures

BACKGROUND: This trial is the first prospective, multicenter clinical nursing trial conducted to measure the effect of nursing interventions on bleeding at the femoral access site after percutaneous coronary intervention with or without a potent antiplatelet agent given along with heparin and aspirin. OBJECTIVE: To measure the relationship between nursing interventions and complications at the arterial access site in patients undergoing percutaneous coronary interventions and to recommend a standard of care to minimize bleeding complications. METHODS: In a descriptive, correlational 4010-patient study, nursing care interventions after coronary procedures were measured. Observed standards of care were assessed, and regression techniques were used to evaluate nursing interventions and the effect of the interventions on bleeding at the access site after percutaneous coronary procedures. RESULTS: Several significant correlations between nursing interventions and the occurrences of moderate to severe bleeding at the access site were found; however, most interventions had little effect. The most significant factors in decreasing complications at the access site were early removal of the arterial sheath, the type of pressure mechanism used to achieve arterial hemostasis, staffing allocation, and the person and method used to remove the sheath. CONCLUSION: Many nursing interventions after percutaneous coronary intervention have become routine in the absence of clinical outcome data. Most nursing interventions aimed at decreasing bleeding at the vascular access site increase nursing workload but do not significantly affect bleeding in the groin. These results underscore the importance of continued clinical research studies to validate nursing practice on the basis of patients' outcomes.

scholarly journals Complex Large-Bore Radial percutaneous coronary intervention: rationale of the COLOR trial study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038042
Author(s):  
Thomas A Meijers ◽  
Adel Aminian ◽  
Koen Teeuwen ◽  
Marleen van Wely ◽  
Thomas Schmitz ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Ethics Committee ◽  
Bleeding Complications ◽  
Access Site ◽  
Femoral Access ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Coronary Lesions

IntroductionThe radial artery has become the standard access site for percutaneous coronary intervention (PCI) in stable coronary artery disease and acute coronary syndrome, because of less access site related bleeding complications. Patients with complex coronary lesions are under-represented in randomised trials comparing radial with femoral access with regard to safety and efficacy. The femoral artery is currently the most applied access site in patients with complex coronary lesions, especially when large bore guiding catheters are required. With slender technology, transradial PCI may be increasingly applied in patients with complex coronary lesions when large bore guiding catheters are mandatory and might be a safer alternative as compared with the transfemoral approach.Methods and analysisA total of 388 patients undergoing complex PCI will be randomised to radial 7 French access with Terumo Glidesheath Slender (Terumo, Japan) or femoral 7 French access as comparator. The primary outcome is the incidence of the composite end point of clinically relevant access site related bleeding and/or vascular complications requiring intervention. Procedural success and major adverse cardiovascular events up to 1 month will also be compared between both groups.Ethics and disseminationEthical approval for the study was granted by the local Ethics Committee at each recruiting center (‘Medisch Ethische Toetsing Commissie Isala Zwolle’, ‘Commissie voor medische ethiek ZNA’, ‘Comité Medische Ethiek Ziekenhuis Oost-Limburg’, ‘Comité d’éthique CHU-Charleroi-ISPPC’, ‘Commission cantonale d'éthique de la recherche CCER-Republique et Canton de Geneve’, ‘Ethik Kommission de Ärztekammer Nordrhein’ and ‘Riverside Research Ethics Committee’). The trial outcomes will be published in peer-reviewed journals of the concerned literature.Trial registration numberNCT03846752.

scholarly journals Comparison of Radial and Femoral Percutaneous Coronary Intervention

2020 ◽  
Vol 18 (3) ◽  
pp. 366-372
Author(s):  
Mahesh Bhattarai ◽  
Arun Maskey ◽  
Ram Kishore Shah ◽  
Buna Bhandari ◽  
Chandramani Adhikari ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Access Site ◽  
Femoral Access ◽  
Radial Approach ◽  
Radial Access ◽  
Clinical Events ◽  
Percutaneous Coronary ◽  
Heart Center

Background: The use of radial access for percutaneous coronary intervention is increasing in Nepal. However, there is limited study on the comparison of radial and femoral access in Nepal. This is the study comparing net adverse clinical events of radial with femoral access for intervention. Methods: This prospective study was conducted at Shahid Gangalal National Heart Center from January 2014 to June 2015 among 849 participations who underwent percutaneous coronary interventions, and 418 radial interventions were compared with 418 femoral interventions. A comparison was done in terms of 30- day rate of net adverse clinical events defined as the composite of death, myocardial infarction, stroke, target lesion revascularization and major bleeding. Results: Incidence of net adverse clinical events was significantly lower in radial compared to femoral approach 18(4.30%) vs. 51 (12.2%), p= <0.001). Mortality observed in the radial approach was significantly lower (p=<0.001) compared to femoral. Procedure success was not significantly different p=0.629.  The trans-radial approach had significantly higher crossover rate (p=0.001). Observed vascular access site complications (p=0.026) and hospital stay (p=<0.0001) were lower in the radial group. Radiation exposure measured by fluoroscopy exposure time was not significantly different between the two groups (p=0.290). Conclusions: Radial access is associated with a lower rate of net adverse clinical events at 30 days compared to femoral access. Radial access is safer and equally effective compared to femoral access in the context of Nepal. Keywords: Femoral; percutaneous coronary intervention; radial

Radial versus femoral access site for percutaneous coronary intervention in patients suffering acute myocardial infarction

2017 ◽  
Vol 130 (5-6) ◽  
pp. 182-189 ◽  
Author(s):  
Christiana Schernthaner ◽  
Matthias Hammerer ◽  
Stefan Harb ◽  
Matthias Heigert ◽  
Kurt Hoellinger ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Access Site ◽  
Femoral Access ◽  
Percutaneous Coronary

scholarly journals Acceptance and safety of femoral versus radial access for percutaneous coronary intervention (PCI): results from a large monitor-controlled German registry (QuIK)

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Jörg Reifart ◽  
Stefan Göhring ◽  
Alexander Albrecht ◽  
Winfried Haerer ◽  
Benny Levenson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Access Site ◽  
Femoral Access ◽  
Radial Approach ◽  
Radial Access ◽  
Invasive Cardiology ◽  
Percutaneous Coronary

Abstract Background In 2015 and 2018, European Society of Cardiology guidelines for percutaneous coronary intervention (PCI) favoring radial access over femoral access were published. These recommendations were based on randomized trials suggesting that patients treated radially experienced reduced bleeding complications and all-cause mortality. We aimed to assess acceptance and results of radial access in a real-world scenario by analyzing all PCI cases in the Quality Assurance in Invasive Cardiology (QuIK) registry. Methods The QuIK registry prospectively collects data on all diagnostic and interventional coronary procedures from 148 private practice cardiology centers in Germany. Major adverse cardiac and cerebrovascular events (MACE) were defined as myocardial infarction, stroke, or death during hospitalization. Results From 2012 to 2018, 189,917 patients underwent PCI via either access method. The rate of radial approach steadily increased from 13 to 49%. The groups did not differ significantly with respect to age or extent of coronary disease. Femoral approach was significantly more common in patients with ST elevation myocardial infarction and cardiogenic shock. Overall, there were significant differences in MACE (radial 0.12%; femoral 0.24%; p < 0.0009) and access site complications (radial 0.2%; femoral 0.8% (p < 0.0009). Conclusion Our data reveals an increase in use of radial access in recent years in Germany. The radial approach emerged as favorable regarding MACE in non-myocardial infarction patients, as well as favorable regarding access site complication regardless of indication for percutaneous intervention.

Abstract 19592: Predictors of Bleeding Complications in Patients Undergoing Percutaneous Coronary Intervention in an Australian Cohort

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Rosanna Tavella ◽  
Matthew Worthley ◽  
Margaret Arstall ◽  
Christopher Zeitz ◽  
John Beltrame
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Real World ◽  
South Australia ◽  
Coronary Intervention ◽  
Current Smoker ◽  
Bleeding Events ◽  
Access Site ◽  
Femoral Access ◽  
Radial Access ◽  
Percutaneous Coronary

Background: Extensive studies have been undertaken to define clinical predictors of bleeding events in patients undergoing percutaneous coronary intervention (PCI). Few studies have included a large cohort of ‘real world’ patients undergoing PCI via a radial approach. Methods: The Coronary Angiogram Database of South Australia (CADOSA) captures all PCI procedures performed in each public hospital in the state of South Australia (population 1.675 million). CADOSA utilizes identical data specifications to CathPCI® Registry. Thus a significant PCI-related bleeding event was defined as blood loss from any location (percutaneous entry site, retroperitoneal, gastrointestinal, genitourinary) within 72 hours of procedure, resulting in a fall in haemoglobin > 3.0g/dL, transfusion, or prolonged hospital admission. Clinical determinants of PCI-related bleeding events were identified in a multivariable logistic regression model. Results: In 2012, there were 1,409 PCI procedures performed, with 80% undertaken for acute coronary syndrome, 56% via radial access, 14% using bivalirudin/enoxaparin and 5% utilizing novel anti-platelet agents (prasugrel 5%, ticagrelor 0.1%). Of these procedures, 1.7% had significant bleeding events. Univariate determinants of bleeding included increasing age, female, current smoker, prior PCI, ST elevation MI presentation, femoral access, cardiogenic shock, intra-aortic balloon pump insertion and administration of clopidogrel, glycoprotein IIb/IIIa inhibitors, verapamil or metaraminol prior/during procedure. The final model identified the following clinical determinants as significant independent predictors of bleeding with a C-index of 0.87: age over 80 years (OR=10.7; 3.4-34.0, p<0.01), current smoker (OR=5.7; 2.0-16.5, p<0.01), the use of glycoprotein IIb/IIIa inhibitor (OR=3.9; 1.4-10.6, p<0.01), use of clopidogrel (2.7; 1.0-7.1, p<0.05) and femoral access site (OR=10.6; 3.1-37.1, p<0.01). Conclusion: In a ‘real world’, representative PCI cohort where radial access approach is frequently used, there was a low prevalence of bleeding events. In addition to access site, several distinctive baseline clinical features along with administration of blood thinning agents predicted bleeding.

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