Percutaneous coronary intervention (PCI) is a primary method for treating coronary heart disease. Nurses use one of three groin compression methods (GCMs) to achieve hemostasis after femoral sheath removal following PCI; manual pressure, C-Clamp, and Femostop®. Patients report mild-moderate discomfort with each GCM; vascular complications (VCs) vary 6-10%. While each GCM has benefits and limitations, no investigations have examined all three simultaneously to determine which is superior. The objective of this study was to determine which GCM following PCI is the most comfortable, least distressful, and produces the fewest VCs.
A convenience sample of 306 PCI patients were recruited from one Midwestern hospital for this three group experimental design study. Participants were randomized to one GCM and rated their discomfort and distress (0-10 scale) prior to sheath removal, 1 minute after compression applied, 1- and 10 minutes after compression released. Groin assessments for VCs (hematoma, ecchymosis, oozing) included prior to, 10-minutes after, 12-, and 24 hours after sheath removal. Generalized estimating equations (GEE) were used to detect any differences in discomfort, distress, and VCs by GCM.
Participants’ mean age was 62.3 (+/- 11.4) with a majority of males (77%; females 23%). There were no differences in distress, discomfort or VCs by GCM. Significant contributors to VCs included: baseline hematoma (z=-9.4; p < .0001); baseline ecchymosis (z=-10.1; p < .0001) and Integrilin (z=-3.0; p=.003); baseline oozing (z=-3.3; p=.001) and time to hemostasis (z=2.6; p=.01).
While no specific GCM was found to cause less discomfort, distress or fewer VCs, the presence of a VC prior to sheath removal, receipt of anti-platelet medication, and longer time to hemostasis are contributors to VCs. Nurses should be vigilant when providing care to PCI patients when these factors are present.
Session #1077 - Acute Care Research: Impacting Patient Care Outcomes
The 29th Annual MNRS Research Conference (April 1-4, 2005)