Molina Allen This presentation was prepared for COHP 450, Section VL1, taught by Dr. Njoku
17
Achieving Hemostasis Post Cardiac Catheterization: Vascular Compression Device vs. Manual Compression Molina Allen This presentation was prepared for COHP 450, Section VL1, taught by Dr. Njoku.
Molina Allen This presentation was prepared for COHP 450, Section VL1, taught by Dr. Njoku
Molina Allen This presentation was prepared for COHP 450,
Section VL1, taught by Dr. Njoku.
Slide 3
Purpose: Explore two methods used to achieve hemostasis after a
cardiac catheterization Assess the strengths and weaknesses of each
in relation to decreasing the time to ambulation PICO Question: In
cardiac patients post percutaneous coronary intervention (PCI),
does the use of a vascular closure device to achieve hemostasis
improve early ambulation rates compared to manual pressure?
Introduction
Behan, M., Large, J., Patel, N., Lloyd, G., & Sulke, A.
(2007). A randomised controlled trial comparing the routine use of
an angio- seal STS device strategy with conventional femoral
haemostasis methods in a district general hospital. International
Journal of Clinical Practice, 61(3), 367-372. Retrieved from doi:
10.1111/j.1742-1241.2006.01229.x Gregory, D., Midodzi, W., &
Pearce, N. (2013). Complications with angio-seal vascular closure
devices compared with manual compression after diagnostic cardiac
catheterization and percutaneous coronary intervention. Journal of
Interventional Cardiology, 26(6), 630-638. Retrieved doi:
10.1111/joic.12070 Articles
Slide 6
Both articles compare and contrast the use of vascular closure
devices (VCD) with manual compression in the goal of achieving
hemostasis after a percutaneous coronary intervention (PCI). The
PICO question presented is in direct relation to the articles. This
presentation intends to answer the question based on the
information provided by the results of the research posed in each
article. Rationale
Slide 7
Methodology Behan et al. Theory Femoral artery closure devices
reduce the time to haemostasis and ambulation following coronary
angiography (Behan et al., 2007). Study & Design Randomized
trial Males Approx. age 65 Angio-Seal 107 (74) Manual Compression
99 (98) Analysis by intention to treat Unpaired Students t- test
Mean values-standard deviation P-values < 0.05 Significant
Slide 8
Methodology Gregory et al. Univariate Analysis 2-sided P-value
< 0.05 Significant Multivariate Logistic Regression Analysis
Propensity score adjusted analysis Theory Use of vascular closure
device (VCD) challenges manual compression as, ... gold standard
for achieving hemostasis for 60 years (Gregory et al., 2013). Study
& Design Secondary analysis from database between 2006-2010
Over 19 years of age Cardiac catheterization or PCI Sample size of
11,897 VCD 59.4%
Slide 9
Findings Behan et al. Gregory et al. VCD use decreased:
Bruising Time lying flat Pain Time in hospital
Slide 10
Ethical Considerations Behan et al. Eastbourne District General
Hospital: Cardiac Department Authors state no conflict of interest
Demographics between two control and trial groups very similar
Subjects were all males Gregory et al. Study approved Human
Investigations Committee of Memorial University and Eastern Health.
Sample size for VCD three times manual pressure group (prospensity
score adjusted) Non-randomization of VCD group
Slide 11
Behan et al. Consistency Control and trial groups similar 3
consultants/3 registrar grade operators Angio-Seal trained by St.
Jude representative 5 french sheath Nursing follow-up 1 week post
procedure Patient questionnaire Article Analysis
Slide 12
Gregory et al. Large study sample Cardiac Catheterization
Database Nurses Research Nurse Managed All VCD procedures completed
by Interventionalists No residents/fellows Minor Complications
Hematoma, pseudoaneurysm, arteriovenous fistula Major Complications
Vascular occlusion, loss of distal pulse, retroperitoneal bleed,
complication during procedure Article Analysis
Slide 13
Increase probability of PCI being day procedure VCD promoted:
Early mobilization Less major/minor complications (Gregory et al.,
2013) ... Considerable waits for this procedure... The newest
version of this device allows rapid mobilisation of uncomplicated
coronary angiography patients(Behan et al., 2007). Regarding
vascular complications: ...PCI sample, the risk was 49% lower if a
VCD was used (Gregory et al., 2013). EBP Contribution
Slide 14
Communication Policy Standardize employment of VCD with PCI
Femoral Approach Nursing Standards Assessment/Evaluation Post
procedure patient instructions Implications Decreased hospital stay
Increased patient ratio Increased reimbursement (Behan et al.,
2007) Article Relevance
Slide 15
Barriers Education Expense Time Training Efficiency
Complications related to competency (Gregory et al., 2013) Article
Relevance
Slide 16
Continuing Research The size of this study did not allow for
the evaluation of rare complications such as infection (Behan et
al., 2007) PICO: In cardiac patients post PCI, what are the rates
of infection when a VCD is utilized to achieve hemostasis compared
to manual pressure? ... There may be potential unmeasured
confounding, a limitation of observational studies such as the
current study... Physicians experience in the use of VCDs was not
available (Gregory et al., 2013) PICO: Does a physicians experience
in utilizing VCDs to achieve hemostasis influence the rate of
complications in patients who have had a PCI over achieving
hemostasis with manual compression? Article Relevance
Slide 17
VCD Use vs. Manual Compression Increased comfort Decreased time
to mobilization Decreased complications Utilized less in high risk
patients Required certain criteria Femoral approach site Increased
use may decrease days hospitalized Allow for increased number of
patients to be treated Conclusion
Slide 18
References Behan, M., Large, J., Patel, N., Lloyd, G., &
Sulke, A. (2007). A randomised controlled trial comparing the
routine use of an angio- seal STS device strategy with conventional
femoral haemostasis methods in a district general hospital.
International Journal of Clinical Practice, 61(3), 367-372.
Retrieved from doi: 10.1111/j.1742-1241.2006.01229.x Gregory, D.,
Midodzi, W., & Pearce, N. (2013). Complications with angio-seal
vascular closure devices compared with manual compression after
diagnostic cardiac catheterization and percutaneous coronary
intervention. Journal of Interventional Cardiology, 26(6), 630-638.
Retrieved doi: 10.1111/joic.12070