Care of the post percutaneous coronary intervention patientMills, Cally;Wright, Christine;Newell, Caroline.Australian Nursing Journal19.7(Feb 2012): 26-7.Turn on hit highlighting for speaking browsersHide highlightingAbstract (summary)TranslateAbstractRecent literature indicates ambulation prior to four hours is preferred practice and does not impact negatively at the femoral site (Augustin et al 2010; Schiks et at 2009; Gillane et al 2009) and has also been investigated to also be a safe practiceinthelow riskelderly population (Rao et al 2oii).The extent to which early ambulation is proving to be safe and does not resultinan increaseincomplications means that same day discharge can be considered for PCI procedures (Rao et al 2011; Heyde et al 2007); and also with the increasing use of the radial artery for PCI access.Full Text TranslateFull text Turn on search term navigationIntroductionThe number of patients undergoing apercutaneouscoronary intervention(PCI) has dramatically increased.InAustraliain2008, 155 per 100,000 of population underwent PCI; compared with 61 per 100,000 undergoingcoronaryartery bypass surgery (AIHW 2010). Evidence regarding current care of the patient post PCI highlightsnursing interventionssuch as:nursingsupine; the time to ambulation following sheath removal; and use of arterial closure devices.InAustralia and New Zealand, a recent study demonstrates a wide variationinroutine practice of cardiac nurses, and a lack of clinical guidelines to assist this process (Rolley et al 2010). This practice opinion article is aimed to discuss recent literatureinregards to advancesin nursingcare for the patient post PCI and the implications this holds for current clinical practice and potentially future research.Nursing interventionsA PCI involves the passing of a catheter through a sheath that is inserted into the femoral artery. The sheath is removed at the end of the procedure and pressure applied to the insertion site (Walker et al 2008). Three mainnursing interventionsinvolvedinpost PCI care are investigated:nursingpatient's supine; the time to ambulation post sheath removal; and the use of vascular closure devices.SupinenursingNursingcare for patients who have undergone PCI involves prevention of potential complications such as haematoma and bleeding from the femoral artery, with supinenursingmost often usedin nursingpractice, particularly soinAustralia and NZ (Rolley et al 2010). Physical complications from supinenursinginclude haemodynamic instability due to the physiological responses to back pain as well as urinary retention (Rezaei et al 2009). A randomised control trial investigating positioning protocols post PCI found that patients who had modified positioning and pillow support had much less back pain with no accompanying increaseincomplications as compared with those who were nursed supine (Rezaei et al 2009). From the patient's perspective, lying supine for long periods of time can have negative impacts such as being dependant on the nurse for bodily function needs, pain and the discomfort of not being able to move freely (Lunden et al 2006). Anxiety associated with physical immobility and pain is also of great importance to patient care, with patients often experiencing a high level of anxiety before the PCI procedure (Trotter et al 2010). Patients also describe anxiety related to being physically immobile for long lengths of time.Time to ambulationThe time to safe mobilisation of patients after sheath removal is open to a variety of interpretations. Current practiceinthe Australian context demonstrates a wide variation of practiceinthis area, with time to ambulation reported from as little as one hour to over eight hours duration (Rolley et al 2010). Recent literature indicates ambulation prior to four hours is preferred practice and does not impact negatively at the femoral site (Augustin et al 2010; Schiks et at 2009; Gillane et al 2009) and has also been investigated to also be a safe practiceinthe low risk elderly population (Rao et al 2oii).The extent to which early ambulation is proving to be safe and does not resultinan increaseincomplications means that same day discharge can be considered for PCI procedures (Rao et al 2011; Heyde et al 2007); and also with the increasing use of the radial artery for PCI access.Use of vascular closure devices (VCDs)The introduction of VCDinthe mid-1990s offered an alternative to the use of manual compression, often seen as the 'gold standard'inprevention of haemorrhage and haematomainthe femoral artery post PCI. CurrentlyinAustralia and New Zealand, only 14.5% of nurses surveyed reported using a vascular closure device, with manual compression being the most common form of femoral artery occlusion (Rolley et al 2010). Current research shows that VCDs are a safe way to achieve femoral artery haemostasis (Iqtidar 2011) while reducing the length of the patient's hospital stay (Alien et al 2011; Falcone et al 2011). Both of these studies also found that patient comfort played a greater roleinreduced length of stay. Unfortunately the main focus of studies carried out on VCDs did not assessnursingcare post procedure. As VCDs are becoming more widely usedinPCI it is apparent this is an area for further exploration of nurses' experience of different VCDs and how the evidence can be used to advance practice.Implications for practice and future researchImplications for clinical practice and future research from this discussion highlight both the humanistic and hi-tech nature of cardiovascularnursing. The theme of anxiety associated with PCI procedure is common and there is currently a paucity of research related to this phenomenon. Falcone et al (2011) suggested patients who stayed overnight post PCI reported a reductioninanxiety. A far cheaper option is implementing improved patient education prior to the PCI procedure, where anxiety could be reduced, thus improving the patient's experience. With the patient experience of supinenursing inmind, nurses should consider that focusing on allaying anxiety and talking with patients whilst lying supine post PCI can be of great clinical benefit (Trotter et al 2010) and is a simple, effective and inexpensivenursingcareinterventionthat can be easily implemented. The use of vascular closure devices requires clinical practice guidelines to aid the clinicianinapplying knowledge to practice, with a recent Australian study (Rolley et al 2011) offering practical, evidence based starting points that cardiovascular nurses can begin to implement.ConclusionUsing contemporary evidence to inform practice is a standard all nurses should strive to achieve. Nurses need to work together with other health care professionals to engageindialogue related to best practices, current trends and innovations to improve the patient clinical benefit.The authors would like to acknowledge Dr Karen-Leigh Edward, Associate Professor ofNursingResearch, Australian Catholic University and St Vincents and Mercy Private Hospital and Ms Annette Silinzieds, Education Coordinator Graduate Programs and Medical Education for facilitating the workshop, "Writing as o Health Professional" held on 5 July and 27 September 2011 which inspired this publication.ReferencesREFERENCES:Australian Institute of Health and Welfare. 2010. Australian health: the i2th biennial health report of the Australian Institute of Health and Welfare. Cat. no. AUS 122. AIHW. Canberra.Alien, D., Marso, S., Lindsey, J., Kennedy, K. and Safley, D. 2011. 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"The effect of three positioning methods on patient outcomes after cardiac catheterization", Journal of AdvancedNursing, 05(2):4i7-24.Rolley, J., Salamonson, Y., Dennison, C. and Davidson, P. 2010. "Nursingcare practices following apercutaneous coronary intervention: results of a survey of Australian and New Zealand cardiovascular nurses", Journal of CardiovascularNursing, 25(i):75-84.Rolley J., Salamonson. Y., Wensley, C., Dennison, C. and Davidson, P. 2011. "Nursingclinical practice guidelines to improve care for people undergoingpercutaneous coronary interventions", Australian Critical Care, 24(i):i8-38.Schiks, I., Schoonhoven, L, Aengevaeren, W., Nogarede-Hoekstra, C., Van Achterberg, T. and Verheugt, F. 2009. "Ambulation after femoral sheath removalin percutaneous coronary intervention: a prospective comparison of early vs late ambulation", Journal of ClinicalNursing, i8(i3):i862-70.Trotter, R., Gallagher, R. and Donoghue, J. 2010. "Anxietyinpatients undergoingpercutaneous coronary interventions", Hearts Lung: The Journal of Acute and Critical Care, 4o(3):185-92.Walker, S., Jen, C., McCosker. F. and Cleary, S. 2008. "Comparison of complicationsin percutaneous coronary interventionpatients mobilized at 3, 4, and 6 hours after femoral arterial sheath removal", Journal of CardiovascularNursing, 23(5):407-13.AuthorAffiliationCALLY MILLS IS A RN AND RESEARCH ASSOCIATE,NURSINGRESEARCH UNIT, ST VINCENT'S AND MERCY PRIVATE HOSPITAL.CHRISTINE WRIGHT IS A RN AND RM AND RESEARCH ASSISTANT, ST VINCENT'S CENTRE FORNURSINGRESEARCH.CAROLINE NEWELL IS A RN AND AUM ANAESTHETICS/PACU, ST VINCENTS AND MERCY PRIVATE HOSPITAL