Research utilization and improvement in outcomes after diagnostic cardiac catheterization

1998 ◽  
Vol 18 (5) ◽  
pp. 30-31 ◽  
Author(s):  
L Lundin ◽  
T Sargent ◽  
L Burke
Keyword(s):  
Cardiac Catheterization ◽  
Research Utilization ◽  
Quality Care ◽  
Vascular Complications ◽  
Bed Rest ◽  
Review Of The Literature ◽  
Published Evidence ◽  
Diagnostic Cardiac Catheterization ◽  
Iowa Model ◽  
Change In Practice

This research utilization project helped summarize the research basis of current practice related to duration of bed rest after cardiac catheterization via the femoral artery. Several physicians have changed their practice as a result of this project, and the safety of patients is being maintained. Interestingly, De Jong and Morton recently published a research analysis of interventions used to control vascular complications after cardiac catheterization. These authors concluded from the review of the literature on duration of bed rest that evidence was sufficient to support a change in practice. Because we thought that the published evidence was insufficient to be used as the sole basis for a change in practice, we continued to follow the Iowa model. Specifically, we integrated scientific principles and expert recommendations with the published research base; recommended a change in practice; and monitored patients' outcomes, which ultimately did confirm the recommendations of De Jong and Morton. We are convinced that the combination of data from our own patients and the review of the literature was helpful to assure our medical and nursing staff that this change in practice was safe. This project illustrates the benefit of using the Iowa Model for Research Based Practice to Promote Quality Care as a guide to improve patients' outcomes.

Complications

2020 ◽  
pp. 277-314
Author(s):  
Andrew Mitchell ◽  
Giovanni Luigi De Maria ◽  
Adrian Banning
Keyword(s):  
Cardiac Catheterization ◽  
Vascular Complications ◽  
Air Embolism ◽  
Limb Ischaemia ◽  
Contrast Nephropathy ◽  
Diagnostic Cardiac Catheterization ◽  
Vasovagal Reactions ◽  
Co Morbidity ◽  
Coronary Perforation ◽  
Haematoma Formation

Cardiac catheterization is an invasive study that involves real risks to the patient. The risks increase with patient age and co-morbidity. Though vascular complications (particularly haematoma formation) and vasovagal reactions are more common, the risk of serious complications from diagnostic cardiac catheterization and coronary angiography remains low. This chapter covers complications that may arise, including death, myocardial infarction, pulmonary oedema, stroke, hypotension, cardiac tamponade, contrast reactions, vasovagal reactions, arrhythmias, vascular complications, limb ischaemia, coronary dissection (including left main stem dissection and iatrogenic type A aortic dissection), air embolism, coronary perforation, renal failure, contrast nephropathy, and cholesterol embolization.

Manual versus mechanical compression for femoral artery hemostasis after cardiac catheterization

1998 ◽  
Vol 7 (4) ◽  
pp. 308-313 ◽  
Author(s):  
A Simon ◽  
B Bumgarner ◽  
K Clark ◽  
S Israel
Keyword(s):  
Cardiac Catheterization ◽  
Femoral Artery ◽  
Vascular Complications ◽  
Control Group ◽  
Mechanical Compression ◽  
Success Rates ◽  
Manual Compression ◽  
Diagnostic Cardiac Catheterization ◽  
Compression Time ◽  
Catheterization Procedure

BACKGROUND: Most cardiac catheterizations are performed via femoral artery access. Reported rates of both peripheral vascular complications and success rates for the use of manual and mechanical compression techniques to achieve femoral artery hemostasis after cardiac catheterization vary. OBJECTIVE: To determine is use of a mechanical clamp is as effective as standard manual pressure for femoral artery hemostasis after cardiac catheterization. METHODS: Subjects consisted of 720 patients from 2 community hospitals who had elective diagnostic cardiac catheterization via the femoral artery. The control group (n=343) received manual compression for hemostasis; the study group (n=377) received mechanical compression. Standard protocols were used for the 2 compression techniques. Pressure was applied for a minimum of 10 minutes for 5F and 6F sheaths and catheters and for a minimum of 15 minutes for 7F and 8F sheaths and catheters. Prospective data were collected and analyzed for each patients, including sheath or catheter size, blood pressure, height, weight, age, time from administration of local anesthetic to successful cannulation of the femoral artery, anticoagulation status, total compression time, physician performing the catheterization procedure, nurse or technician who obtained hemostasis, and complications. In follow-up, patients were asked site-specific and functional status questions 1 to 2 days after the catheterization procedure and again 3 days after the catheterization procedure. RESULTS: Data were analyzed by using frequency distributions, measures of central tendency, and measures of variability. Only 1 difference between the 2 groups was significant: manual compression time was 14.93 +/- minutes, whereas mechanical compression time was 17.13 +/- minutes. CONCLUSION: Mechanical compression is as effective as manual compression for femoral artery hemostasis after cardiac catheterization.

scholarly journals Reducing bed rest time from five to three hours does not increase complications after cardiac catheterization: the THREE CATH Trial

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Roselene Matte ◽  
Thamires de Souza Hilário ◽  
Rejane Reich ◽  
Graziella Badin Aliti ◽  
Eneida Rejane Rabelo-Silva
Keyword(s):  
Cardiac Catheterization ◽  
Intervention Group ◽  
Vascular Complications ◽  
Bed Rest ◽  
Group Differences ◽  
Control Group ◽  
Common Complication ◽  
Catheterization Laboratory ◽  
Vasovagal Reaction ◽  
Rest Time

Abstract Objective: to compare the incidence of vascular complications in patients undergoing transfemoral cardiac catheterization with a 6F introducer sheath followed by 3-hour versus 5-hour rest. Methods: randomized clinical trial. Subjects in the intervention group (IG) ambulated 3 hours after sheath removal, versus 5 hours in the control group (CG). All patients remained in the catheterization laboratory for 5 hours and were assessed hourly, and were contacted 24, 48, and 72 h after hospital discharge. Results: the sample comprised 367 patients in the IG and 363 in the GC. During cath lab stay, hematoma was the most common complication in both groups, occurring in 12 (3%) IG and 13 (4%) CG subjects (P=0.87). Bleeding occurred in 4 (1%) IG and 6 (2%) CG subjects (P=0.51), and vasovagal reaction in 5 (1.4%) IG and 4 (1.1%) CG subjects (P=0.75). At 24-h, 48-h, and 72-h bruising was the most commonly reported complication in both groups. None of the comparisons revealed any significant between-group differences. Conclusion: the results of this trial show that reducing bed rest time to 3 hours after elective cardiac catheterization is safe and does not increase complications as compared with a 5-hour rest. ClinicalTrials.gov Identifier: NCT-01740856

scholarly journals Complications of Diagnostic Cardiac Catheterization in National Heart Centre, Nepal

2017 ◽  
Vol 6 (1) ◽  
pp. 13-16
Author(s):  
Arun Maskey ◽  
Shyam Raj Regmi ◽  
Laxman Dubey ◽  
Yadav Bhatt ◽  
Rabi Malla ◽  
...  
Keyword(s):  
Cardiac Catheterization ◽  
Vascular Complications ◽  
Left Heart ◽  
Coronary Angiogram ◽  
Cerebrovascular Complication ◽  
Artery Thrombosis ◽  
National Heart ◽  
Diagnostic Cardiac Catheterization ◽  
Heart Study ◽  
Venous Fistula

Cardiac Catheterization for diagnostic has been routinely used for the last few years in national heart centre in Nepal. Complications have been recognized as an important factor in morbidity and mortality after diagnostic catheterization. Improvements of technique and technology have reduced the morbidity of routine diagnostic catheterization, but occasional mortality seems to be unavoidable. A total of 6074 consecutive diagnostic cardiac diagnostic cardiac catheterization performed in Shahid Gangalal National Heart Centre, Kathmandu, Nepal between 2004 to 2008 were evaluated for their complications. Among them 4584 (75.46%) were coronary angiogram. 894 (14.71%) were right heart study and 596 (9.81%) were left heart study. There were 5 deaths (0.09%). Four deaths occurred following coronary angiogram and I death following left heart study in a 3 years old boy with Tetralogy of Fallot. Vascular complications occurred in 20(0.33% patients) with groin haematoma in 8 (0.13%), pseudoaneurysm in 5 (0.09%), arterrio venous fistula in 3 (0.05%) and femoral artery thrombosis in 4 (0.06%) patients. Contrast allergy occurred in 7(0.12%), cerebrovascular complication in 3 (0.05%), vasovagal reaction in 5 (0.09%) and pyrogen reaction in 10 (0.16%) of patients. The diagnostic cardiac catheterization in national heart centre has acceptable low rate of complication which includes death.

scholarly journals Difference of Radial Access and Femoral Access on Patient Outcomes in Diagnostic Cardiac Catheterization: A Quasi-Experimental Study

2018 ◽  
Vol 12 (3) ◽  
pp. 73-81
Author(s):  
Xi Cao ◽  
Sui Ying Fung ◽  
Yuen Yi Lai ◽  
Sek Ying Chair ◽  
Han Shi Jocelyn Chew
Keyword(s):  
Back Pain ◽  
Cardiac Catheterization ◽  
Vascular Complications ◽  
Secondary Data ◽  
Transfemoral Approach ◽  
Femoral Access ◽  
Diagnostic Cardiac Catheterization ◽  
Alternative Approach ◽  
Significant Difference ◽  
Quasi Experimental

BackgroundTransfemoral and transradial are two common approaches for performing cardiac catheterization, while there is no consensus on which one is superior to the other.AimThis paper aimed to compare the effect of transfemoral and transradial approaches on patient's outcomes in terms of back pain, vascular complications, and urinary discomfort in those undergoing diagnostic cardiac catheterization.MethodsA secondary data analysis method was used.ResultsThe results showed that transradial access could significantly reduce back pain compared to femoral access. While no significant difference was found for vascular complications and urinary discomfort between the two methods.ConclusionThe findings of this study indicate that transradial approach could reduce patients' back pain without increasing the incidence of vascular complications. Additionally, with early mobility, nursing care time could be reduced. Thus, it can be used as an alternative approach for the transfemoral approach.

scholarly journals Benchmarking experience to improve paediatric healthcare: listening to the voices of families from two European Children’s University Hospitals

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ilaria Corazza ◽  
Kendall Jamieson Gilmore ◽  
Francesca Menegazzo ◽  
Valts Abols
Keyword(s):  
Children And Adolescents ◽  
Quality Care ◽  
University Hospital ◽  
Free Text ◽  
University Hospitals ◽  
Post Discharge ◽  
Important Indicator ◽  
Published Evidence ◽  
Patient Reported ◽  
Electronic Administration

Abstract Background Patient Reported Experience Measures (PREMs) are recognized as an important indicator of high quality care and person-centeredness. PREMs are increasingly adopted for paediatric care, but there is little published evidence on how to administer, collect, and report paediatric PREMs at scale. Methods This paper describes the development of a PREMs questionnaire and administration system for the Meyer Children’s University Hospital in Florence (Meyer) and the Children’s Clinical University Hospital in Riga (CCUH). The system continuously recruits participants into the electronic administration model, with surveys completed by caregivers or adolescents at their convenience, post-discharge. We analyse 1661 responses from Meyer and 6585 from CCUH, collected from 1st December 2018 to 21st January 2020. Quantitative and qualitative experience analyses are included, using Pearson chi-square tests, Fisher’s exact tests and narrative evidence from free text responses. Results The large populations reached in both countries suggest the continuous, digital collection of paediatric PREMs described is feasible for collecting paediatric PREMs at scale. Overall response rates were 59% in Meyer and 45% in CCUH. There was very low variation in mean scores between the hospitals, with greater clustering of Likert scores around the mean in CCUH and a wider spread in Meyer for a number of items. The significant majority of responses represent the carers’ point of view or the perspective of children and adolescents expressed through proxy reporting by carers. Conclusions Very similar reported scores may reflect broadly shared preferences among children, adolescents and carers in the two countries, and the ability of both hospitals in this study to meet their expectations. The model has several interesting features: inclusion of a narrative element; electronic administration and completion after discharge from hospital, with high completion rates and easy data management; access for staff and researchers through an online platform, with real time analysis and visualization; dual implementation in two sites in different settings, with comparison and shared learning. These bring new opportunities for the utilization of PREMs for more person-centered and better quality care, although further research is needed in order to access direct reporting by children and adolescents.

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