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Ambulation after femoral sheath removal in percutaneous coronary intervention: a prospective comparison of early vs. late ambulation

Ambulation after femoral sheath removal in percutaneous coronary intervention: a prospective comparison of early vs. late ambulation
Ambulation after femoral sheath removal in percutaneous coronary intervention: a prospective comparison of early vs. late ambulation
Aim and objectives. To investigate if ambulation four hours after sheath removal can replace ambulation 10 hours or more after sheath removal with regard to puncture site complications after percutaneous coronary interventions and to examine patient comfort in both groups.

Background. Early ambulation after percutaneous coronary intervention may facilitate earlier hospital discharge. Whether this approach is safe, is unknown.

Design. A non-randomised comparative study.

Methods. Percutaneous coronary intervention was performed by femoral approach. Registered nurses of the ward removed the sheath and haemostasis was achieved by manual compression. After bed rest with a compression bandage for four hours, the patients in the early ambulation group were ambulated. The patients in the control group stayed in bed till the next morning. Primary study endpoint was the composition of puncture site complications: haematoma, bleeding, false aneurysm and arteriovenous fistula. Secondary endpoints were occurrence of vasovagal collapse after mobilisation, back pain and problems with voiding.

Results. In the early ambulation group (n = 329) the total number of complications was nine (2.7%), vs. six (3.0%) in the control group (n = 202). The complication rate in the early ambulation group is not increased compared to the control group (test for non-inferiority p = 0.002). Hence non-inferiority is accepted and practical equivalence shown. There were no statistically significant differences concerning patient comfort between the groups.

Conclusions. Early ambulation four hours after femoral sheath removal is feasible and safe. The incidence of puncture site complications in the early ambulation group is not increased in comparison with the group with prolonged bed rest.

Relevance to clinical practice. Patients could possibly be discharged earlier after percutaneous coronary intervention, allowing percutaneous coronary intervention in an ambulant setting. Further research should confirm these findings and extend the research to the effect of various closure devices in early ambulation and on patients’ well-being.
clinical trial, comfort, coronary heart disease, evidence-based practice, hospital care, nursing care
0962-1067
1862-1870
Schiks, Ingrid E.J.M.
7801bf4f-210b-439b-bf84-5ee695193d15
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Aengevaeren, Wim R.M.
03ef5b8d-b582-4fc6-acd8-091dd6674f1b
Nogarede-Hoekstra, Coby
3ec8526f-b867-424e-81dc-cd0cacc40c8d
van Achterberg, Theo
eb49404e-62c6-427d-bb94-580254177a30
Verheugt, Freek W.A.
6cbe7a8e-c04f-4dc9-b7a3-e24dd3f02e4c
Schiks, Ingrid E.J.M.
7801bf4f-210b-439b-bf84-5ee695193d15
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Aengevaeren, Wim R.M.
03ef5b8d-b582-4fc6-acd8-091dd6674f1b
Nogarede-Hoekstra, Coby
3ec8526f-b867-424e-81dc-cd0cacc40c8d
van Achterberg, Theo
eb49404e-62c6-427d-bb94-580254177a30
Verheugt, Freek W.A.
6cbe7a8e-c04f-4dc9-b7a3-e24dd3f02e4c

Schiks, Ingrid E.J.M., Schoonhoven, Lisette, Aengevaeren, Wim R.M., Nogarede-Hoekstra, Coby, van Achterberg, Theo and Verheugt, Freek W.A. (2009) Ambulation after femoral sheath removal in percutaneous coronary intervention: a prospective comparison of early vs. late ambulation. Journal of Clinical Nursing, 18 (13), 1862-1870. (doi:10.1111/j.1365-2702.2008.02587.x). (PMID:19077015)

Record type: Article

Abstract

Aim and objectives. To investigate if ambulation four hours after sheath removal can replace ambulation 10 hours or more after sheath removal with regard to puncture site complications after percutaneous coronary interventions and to examine patient comfort in both groups.

Background. Early ambulation after percutaneous coronary intervention may facilitate earlier hospital discharge. Whether this approach is safe, is unknown.

Design. A non-randomised comparative study.

Methods. Percutaneous coronary intervention was performed by femoral approach. Registered nurses of the ward removed the sheath and haemostasis was achieved by manual compression. After bed rest with a compression bandage for four hours, the patients in the early ambulation group were ambulated. The patients in the control group stayed in bed till the next morning. Primary study endpoint was the composition of puncture site complications: haematoma, bleeding, false aneurysm and arteriovenous fistula. Secondary endpoints were occurrence of vasovagal collapse after mobilisation, back pain and problems with voiding.

Results. In the early ambulation group (n = 329) the total number of complications was nine (2.7%), vs. six (3.0%) in the control group (n = 202). The complication rate in the early ambulation group is not increased compared to the control group (test for non-inferiority p = 0.002). Hence non-inferiority is accepted and practical equivalence shown. There were no statistically significant differences concerning patient comfort between the groups.

Conclusions. Early ambulation four hours after femoral sheath removal is feasible and safe. The incidence of puncture site complications in the early ambulation group is not increased in comparison with the group with prolonged bed rest.

Relevance to clinical practice. Patients could possibly be discharged earlier after percutaneous coronary intervention, allowing percutaneous coronary intervention in an ambulant setting. Further research should confirm these findings and extend the research to the effect of various closure devices in early ambulation and on patients’ well-being.

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Published date: July 2009
Keywords: clinical trial, comfort, coronary heart disease, evidence-based practice, hospital care, nursing care
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 339224
URI: http://eprints.soton.ac.uk/id/eprint/339224
ISSN: 0962-1067
PURE UUID: 61d5fc76-0c51-4c5a-a7d0-f773f2018c00
ORCID for Lisette Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766

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Date deposited: 25 May 2012 11:08
Last modified: 15 Mar 2024 03:41

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Contributors

Author: Ingrid E.J.M. Schiks
Author: Wim R.M. Aengevaeren
Author: Coby Nogarede-Hoekstra
Author: Theo van Achterberg
Author: Freek W.A. Verheugt

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