Groin Dressing post Cardiac Catheterization: Traditional pressure Versus Transparent Film. BSN, MSN, Clinical nursing, Critical Care Nursing

Transcription

1 Groin Dressing post Cardiac Catheterization: Traditional pressure Versus Transparent Film BSN, MSN, Clinical nursing, Critical Care Nursing

2 Introduction Transfemoral percutaneous coronary procedures have evolved in the past several years as a mainstay in both diagnostic and interventional cardiology. There are 2.7 million caths done in the US each year: 67 % diagnostic caths, 33 % interventional caths.* * source: American Heart Association.

3 Introduction (cont.) These procedures involving arterial puncture carry a risk of access site complications estimated to occur in 1% to 5% of procedures. (Boonbaichaiyapruck S, JMAT, 2005) Pressure dressing has been used as the standard following sheath removal.

4 Review of literature

5 Review of literature clinical evidence suggests that patients often experience considerable discomfort associated with the use of pressure bandaging. (Botti M, Heart&Lung, 2009)

6 Transparent Film Dressing

7 Transparent Film Dressing (Cont.) Transparent Film Dressing (TFD) after cardiac catheterization approved and rated butter with regard to: comfort, ease of use, ease of dressing removal, less pain, decrease hematoma formation. (Mcle S, AJCC, 2009)

8 This type of dressing facilitate nurses assessment of the puncture site.

9 Methodology

10 Methodology Aim The aim of the study was to compare the effectiveness of using transparent film dressing (TFD) vs. pressure dressing with respect to 3 outcomes: bleeding and hematoma, satisfaction of patients, and ease of nursing assessment of the sheath insertion site in the groin after cardiac catheterization.

11 Methodology Design/Setting Design: An experimental design was used. Setting: The study was conducted in the cardiac catheterization unit at King Fahd University Hospital (KFUH), Al-Khobar, Eastern Province.

12 Methodology Subject Subject: A random sample of 80 patients underwent cardiac catheterization (diagnostic therapeutic) through femoral approach were included in this study. All nurses enrolled in the unit or wards where patients were admitted after CAG or PTCA were also included.

13 Methodology Subject - Exclusion criteria Hematoma greater than 2 cm right after the cardiac catheterization procedure Compression time more than 40 minutes On an active anticoagulation regimen

14 Methodology Subject - Exclusion criteria (Cont.) Inability to lie flat for at least 8 hrs Hemodynamic instability Known to be allergic to any of the dressing material Unwilling to participate and no informed consent

15 Methodology Data Collection Tools 1) Demographic and Medical Data Sheet 2) Hematoma Formation and Bleeding Scale 3) Skin Integrity Scale 4) Patient Discomfort and Pain Scale 5) Nurses Ease of Assessment Scale

16 Methodology Procedure A permission to conduct the study was obtained from the institutional ethical committee. A Pilot study was carried out on five patients. Permission of patients was obtained to share in this study.

17 Methodology Procedure (Cont.) Patients were divided randomly to two groups: Group-1 were assigned to conventional pressure dressing. Group-2 were assigned to light Transparent Film Dressing.

18 Methodology Procedure (Cont.) Both groups were closely monitored in regard to: Bleeding or hematoma formation Patient discomfort or complaint

19 Methodology Procedure (Cont.) The nurses assessed patients every 4 hours for complaints of discomfort. They also recorded whether they were able to observe the groin site directly and rated the ease of assessment of the groin site. Patients ambulated 8 hrs after the procedure.

20 Results Results of the study showed that the mean age of patients was 54.8 ± 10.7 years, more than half of the patients were females (70%). A 6-Fr arterial sheath was used in all patients. The mean of BMI was 30.5±3.24.

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23 Impact of Type of dressing used on skin integrity. After 6-8 hrs After 12-16hrs Press Dressing 40 TFD Vesiculation Erythema & Induration Definite Erythema Negative 4 32 Press Dressing 1 37 TFD

24 Impact of Type of dressing used on hematoma formation. immediately After 6-8 hrs After hrs Benign Small Moderate Large Pressure Dressing TFD Pressure Dressing TFD Pressure Dressing TFD

25 Impact of Type of dressing used on patient discomfort and pain * Pressure Dressing TFD Very comfortable Moderate Most Painful

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27 Impact of type of dressing used on nurses ease of assessment of the groin difficult moderate easy pressure dressing TFD

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29 Conclusion Dressing of the puncture site after cardiac catheterization with TFD was more comfortable than the conventional pressure dressing without any difference in hematoma or bleeding complications.

30 Recommendation Based on the results of the present study, it can be recommended that: TFD can be used safely and comfortably after achieving hemostasis for both diagnostic and therapeutic cardiac catheterization

31 Recommendation (Cont.) Clinical educators and clinical nurse specialists are in a position to identify variation in nursing practice and implementation of evidence-based care to ensure positive clinical outcomes for all patients.

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