Reducing time in bed after percutaneous transluminal coronary angioplasty (TIBS III)

2000 ◽  
Vol 9 (3) ◽  
pp. 185-187 ◽  
Author(s):  
AW Keeling ◽  
CA Fisher ◽  
KH Haugh ◽  
ER Powers ◽  
MS Turner
Keyword(s):  
Femoral Artery ◽  
Coronary Angioplasty ◽  
Medical Center ◽  
Percutaneous Transluminal Coronary Angioplasty ◽  
Control Group ◽  
Control Group Design ◽  
Time In Bed ◽  
Transluminal Coronary Angioplasty ◽  
Percutaneous Transluminal ◽  
Experimental Group

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.

Association of Antibodies to Heat-Shock Protein-65 with Percutaneous Transluminal Coronary Angioplasty and Subsequent Restenosis

1996 ◽  
Vol 75 (02) ◽  
pp. 258-260 ◽  
Author(s):  
Manjari Mukherjee ◽  
Christine De Benedictis ◽  
David Jewitt ◽  
Vijay V Kakkar
Keyword(s):  
Heat Shock ◽  
Heat Shock Protein ◽  
Coronary Angioplasty ◽  
Percutaneous Transluminal Coronary Angioplasty ◽  
Favourable Outcome ◽  
Control Group ◽  
The Mean ◽  
Transluminal Coronary Angioplasty ◽  
Antibody Levels ◽  
Percutaneous Transluminal

SummaryHeat-shock protein (HSP)-65 of mycobacterial origin has been implicated in the mediation of atherosclerosis by immune mechanisms. Any role of HSP-65 in mediating restenosis is however not clear. We determined the anti-HSP-65 antibodies in 28 patients, 25 male and 3 female, aged 35 to 78 years, with coronary artery disease (CAD) and undergoing percutaneous transluminal coronary angioplasty (PTCA). Of the 28 patients, 12 suffered restenosis five to seven months later.The serum levels of antibody were measured at baseline, immediately after PTCA, before discharge from the hospital, and at 6 weeks, 3 and 6 months after the performance of PTCA. The antibody levels were expressed in OD U/log titre, as explained in the text, and termed estimated OD or EOD. The control group consisted of 29 healthy volunteers, 16 male and 13 female, aged 24 to 59 years. The mean Eod of the patients at baseline was higher than that of the controls (0.60 ± 0.12, SD; 95% Cl 0.56-0.64 compared with 0.53 ± 0.13; 0.48-0.58; p < 0.01). There was no correlation between age and EOD of patients, controls or both taken together, ruling out the influence of age on the EOD changes in the given age range. The mean antibody levels of the patients with CAD were similar whether or not they suffered subsequent restenosis (0.61 ± 0.15; 0.53-0.69 in the patency group, and 0.60 ± 0.10; 0.54-0.66 in the restenosis group). However, the patients who did not develop restenosis had a drop in their antibody levels immediately after PTCA (0.51 ± 0.14; 0.48-0.55; 2-tailed p = 0.029), and at discharge from the hospital (0.52 ± 0.15; 0.44-0.60; p = 0.036) as compared with the baseline. This decrease of antibodies was not observed in the restenosis group. Furthermore, the anti-HSP-65 antibody levels remained slightly low throughout the 6-month follow-up in the patients with patent coronaries as compared with patients who reste-nosed, but the decrease was statistically not significant at 5% level at any stage. Besides the anti-HSP-65 antibodies, the levels of anticardio-lipin (ACL) antibody were also measured in all the patients. The levels of the ACL antibody were found to be within the normal range before and at all stages after PTCA, ruling out the PTCA-associated change in the anti-HSP-65 antibody as a non-specific occurrence. Thus, a drop in the level of antibody against HSP-65 after PTCA seemed to be associated with a favourable outcome, and may serve as a useful prognostic marker of coronary angioplasty

Effects of 3 analgesic regimens on the perception of pain after removal of femoral artery sheaths

2000 ◽  
Vol 9 (2) ◽  
pp. 125-129 ◽  
Author(s):  
TR Fulton ◽  
GI Peet ◽  
MA McGrath ◽  
JD Hilton ◽  
RE Smith ◽  
...  
Keyword(s):  
Side Effects ◽  
Femoral Artery ◽  
Coronary Angioplasty ◽  
Percutaneous Transluminal Coronary Angioplasty ◽  
Rescue Analgesia ◽  
Intravenous Fentanyl ◽  
Pain Scores ◽  
Intravenous Morphine ◽  
Transluminal Coronary Angioplasty ◽  
Percutaneous Transluminal

BACKGROUND: Effective pain management after removal of femoral artery sheaths after percutaneous transluminal coronary angioplasty is highly individualized and requires frequent, accurate assessment and administration of analgesics as needed. OBJECTIVE: To determine which of 3 analgesic regimens is most effective in decreasing patients' perception of pain with the fewest side effects after removal of a femoral artery sheath. SAMPLE: 130 adult who had undergone percutaneous transluminal coronary angioplasty and were in an 8-bed cardiac short-stay unit in a 1400-bed acute care hospital. METHOD: Patients were randomized to receive either intravenous morphine, intravenous fentanyl, subcutaneous lidocaine around the sheath site, or an intravenous placebo before sheath removal. Rescue analgesia (intravenous fentanyl) was made available to all groups. Patients used a visual analog scale to assess pain within 10 minutes before, 1 minute after, and 20 minutes after sheath removal. Pain levels, frequency of side effects, and use of rescue analgesia were compared among groups. RESULTS: Age, sex, number of stents, and frequency of hematomas did not differ significantly among groups. Pain ratings, use of rescue analgesia, and side effects (nausea, vomiting, or vasovagal symptoms) were not significantly different among treatment groups. Ratings of pain were slightly higher immediately after sheath removal in all groups. CONCLUSION: For most patients, removal of femoral artery sheaths and manual compression for hemostasis are relatively pain-free. Pain scores among patients given analgesia with subcutaneous lidocaine, intravenous morphine, or intravenous fentanyl were not significantly different from pain scores among control patients.

A randomized clinical trial of the effect of bed position after PTCA

1995 ◽  
Vol 4 (3) ◽  
pp. 221-226 ◽  
Author(s):  
LM Sulzbach ◽  
BH Munro ◽  
Hirshfeld JWJr
Keyword(s):  
Clinical Trial ◽  
Back Pain ◽  
Randomized Clinical Trial ◽  
Coronary Angioplasty ◽  
Percutaneous Transluminal Coronary Angioplasty ◽  
Bleeding Complications ◽  
Control Group ◽  
Bed Position ◽  
Transluminal Coronary Angioplasty ◽  
Percutaneous Transluminal

BACKGROUND: After percutaneous transluminal coronary angioplasty, prolonged supine bedrest with the bed flat frequently causes back pain. This study was conducted to examine whether percutaneous transluminal coronary angioplasty patients could adjust their bed position to make themselves comfortable without increasing the frequency or severity of bleeding complications. OBJECTIVES: To determine whether the risk of bleeding increased in patients who were allowed to use their bed controls to make themselves comfortable, and if the difference in comfort was significant between patients who controlled and elevated their bed position and patients who remained flat in bed. METHOD: A randomized clinical trial was conducted; 54 patients undergoing percutaneous transluminal coronary angioplasty were randomly assigned to either the control group, in which patients remained flat in bed, or the experimental group, in which they controlled their bed position. Outcome measures included amount of bleeding at the catheter sites and patient comfort. RESULTS: No difference in the amount of bleeding at catheter insertion sites was found between the two groups. Few subjects reported pain at any time. Back pain at dinner and bedtime was higher in the control group, but only the bedtime difference was statistically significant. CONCLUSION: We conclude that patients may be allowed to adjust their bed position to 30 degrees for comfort without incurring increased risk of catheter entry site bleeding and that requiring patients to remain flat in bed has no scientific basis.

Sign in / Sign up

Export Citation Format

Share Document