Manual compression vs closure
- 1. Manual Compression vs. Arterial Puncture Closing Devices Following Femoral Cardiac Catheterization Rachel Wilkinson Stephanie Ford Brenna Johnson Michelle Giddens
- 2. Discussion • Identify the problem • Review of literature • Recommended Protocol/Procedure/Intervention • Suggestions for further study
- 3. Identifying the Problem • Coronary Artery Disease is the leading cause of death in the United States (Centers for Disease Control And Prevention, 2004). • Cardiac catheterization is one of the most common procedures in the United States (Harper, 2007). – 1.5 million will receive a cardiac catheterization this year – In 2%-10% of cases, vascular complications will occur • Oklahoma is ranked 8th in the nation for being one of the ―fattest‖ states. – 65.1% of Oklahoma’s population falls in to the category of obese or overweight (Calorielab,2008).
- 4. PICO Question • Which arterial closure method is safer, more effective, and causes less vascular complications following cardiac catheterization in adults—the use of manual compression or the use of arterial puncture closing devices (APCDs)?
- 5. Identifying the Problem Continued PICO • Population: Adult patients18 and older receiving femoral cardiac catheterization including all genders and ethnicities • Intervention: Arterial puncture closure devices (APCDs) to achieve hemostasis • Comparison: Manual pressure to achieve hemostasis • Outcome: Decrease vascular complications
- 6. Review of Literature • Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: systematic review and meta-analysis (Koreny et al., 2004). – Systematic review and meta-analysis consisting of 30 randomized controlled trials – Measured risk of acquiring hematomas, bleeding, developing an arteriovenous fistula, and pseudoaneurysm when using APCDs – Manual compression was determined to be the best way to prevent complications following cardiac catheterization
- 7. Review of Literature Continued • A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices (Nipun, Matheny, & Sepke, 2006). – Single study comparing manual compression to the use of APCDs and the complications associated with each after cardiac catheterization – The results revealed that there was a 58% reduction in the risk of vascular complication when APCDs were used after diagnostic cardiac catheterization as opposed to using manual compression
- 8. Review of Literature Continued • Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: A meta-analysis (Nikolsky et al., 2004). – Systematic review and meta-analysis consisting of 30 studies including 37,066 patients comparing the vascular complications that result from either manual compression or the use of APCDs after cardiac catheterization – This study concluded that there was no significant difference in vascular complications when an APCD was used compared to manual compression after femoral cardiac catheterization
- 9. Review of Literature Continued • Vascular complications with newer generations of angioseal vascular closure devices (Applegate et al., 2006). – A single study that compared newer generations of a particular type of APCD called Angioseal to manual compression and older generations of Angioseals after cardiac catheterization – The results in this study concluded that the older and newer generations of Angioseal proved to have similar or lower vascular complications than that of manual compression
- 10. Review of Literature Continued • Risk of local adverse events following cardiac catheterization by hemostasis device use and gender (Tarvis, et al., 2004). – Single study that compared complications following the use of two types of hemostasis devices (sutures and collagen plugs) to manual compression • Complication rates were assessed by gender – Complications were less common in patients who used suture devices or collagen plugs following diagnostic cardiac catheterization than those who used manual compression – Complications were more frequent in females than in males due to smaller vessel size and/or hormonal differences
- 11. Review of Literature Continued • Risk of Local Adverse Events following Cardiac Catheterization by Hemostasis Device Use -- Phase II (Tavris et al., 2005). – Single study that assessed the risks of vascular complications by the type of APCD used compared to manual compression – The results of this article revealed that vascular complications were similar between most APCDs and manual compression after cardiac catheterization – Women were at twice the risk for any vascular complication compared to men
- 12. Review of Literature Continued • Predictors of Vascular Complications Post Diagnostic Cardiac Catheterization and Percutaneous Coronary Interventions (Dumont, C. J., Keeling, A. W., Bourguignon, C., Sarembock, I. J., & Turner, M.,2006). – This article was a retrospective, descriptive and correlational study – The population studied consisted of 11,110 patients whose records were retrieved from the Clinical Automated Office Solutions database – Results of this study found that vascular complications occurred more often in patients whose age was greater than 70 years, being female, having hypertension, and renal failure
- 13. Review of Literature: Manual Compression Pros Cons • Easy to learn • Painful • Safe and Effective • Prolonged mean time to • No requirement for special achieve hemostasis (15-20 equipment minutes) • Prolonged time to ambulation (4-6 hours) • Vascular complications • Nurse arm and hand fatigue • Longer hospital stay
- 14. Review of Literature: APCDs Pros Cons • Shorten the mean time to • Costly ($190-$200) achieve hemostasis (1.46- • May take up to 20 cases for 8.2 minutes) a physician to become • Shorten the mean time to proficient ambulation (2.2-4.5 hours) • Many nurses have a • Increases patient comfort knowledge deficit in regards • Decrease hospital stay to APCDs • Safe and Effective • Vascular complications • Decreases cost to patients
- 15. Recommendation • Our Recommendation: – Nurses to become advocates for APCD use in non-high-risk patients – Multidisciplinary approach to develop a high-risk checklist
- 16. Recommendations Continued • Our recommendations are based on Kurt Lewin’s Change Theory (Yoder- Wise, 2007): – Unfreezing – Experiencing the change – Refreezing
- 17. Recommendations Continued • Unfreezing – Awareness • Formal Channels – High-risk checklist – In-services • Informal Channels – Talking with floor nurses/physicians
- 18. Recommendations Continued • Experiencing the change – Incorporating the use of APCDs • Praise nursing staff • Encouraging doctors
- 19. Recommendations Continued • Refreezing – Evaluation • Formal Channels • Informal Channels – Acceptance • Determined by surveys given to patients, nurses, and doctors
- 20. Suggestions • Alternative approach to studying the problem – Chart trends comparing APCDs to manual compression
- 21. Suggestions Continued • Research Questions: – In APCDs, are the efficacy rates the same for using a suture device compared to a collagen plug? – Is standard manual compression better than mechanical compression devices such as Femostop and C-clamps?
- 22. Any Questions?
- 23. References • Applegate, R.J., Sacrinty, M., Kutcher, M.A., Sanjay, G.K., Talal, B.T., Renato, S.M., William, L.C. (2006). Vascular complication with newer generations of angioseal vascular closure devices. Journal of Interventional Cardiology, 19(1), 67-74. • Calorielab. (2008). Mississippi is the fattest state for 3rd straight year, Colorado still leanest, D.C. loses weight. Retrieved March 24, 2009, from http://calorielab.com/news/2008/07/02/fattest- states-2008/
- 24. References Continued • Centers For Disease Control And Prevention. (2004). Division for Heart Disease and Stroke Prevention. Retrieved March 28, 2009, from Department of Health and Human Services Web site: http://www.cdc.gov/dhdsp/state_program/ok.htm • Dumont, C. J., Keeling, A. W., Bourguignon, C., Sarembock, I. J., & Turner, M. (2006). Predictors of vascular complications post diagnositc cardiac catheterization and percutaneous coronary interventions. Dimensions of Critical Care Nursing, 25(3),137-142. • Harper, J. P. (2007). Post-diagnostic cardiac catheterization. Journal For Nurses in Staff Development , 23(6), 271-276.
- 25. References Continued • Koreny, M., Riedmuller, E., Nikfardjam, M., Siostrzonek, P., Mullner, M. (2004). Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: Systematic review and meta-analysis. American Medical Association, 291(3), 350-357. • Nikolsky, E., Roxana, M., Amir, H., Aymong, E.D., Mintz, G.S., Lasic, Z., Negoita, M., Fahy, M., Krieger, S., Moussa, I., Moses, J.W., Stone, G.W., Leon, M.B., Pocock, S.J., Dangas, G. (2004). Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: A meta-analysis. Journal of the American College of Cardiology, 44(6), 1200-1209.
- 26. References Continued • Nipun, A., Matheny, M.E., Sepke, C. (2006). A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices. American Heart Journal, 153(4), 606-611. • Tavris, D. R., Dey, S., Albrecht-Gallauresi, B., Brindis, R.G., Shaw, R., Weintraub, W., Mitchel, K. (2005). Risk of local adverse events following cardiac catheterization by hemostasis device use: Phase II. The Journal of Invasive Cardiology, 17(12), 644-650. • Tarvis, D. R., Gallauresi, B. A., Rich, S. E., Shaw, R. E., Weintraub, W. S., Brindis, R. G., et al. (2004). Risk of local adverse events following cardiac catheterization by hemostasis device use and gender. The Journal of Invasive Cardiology , 16 (9), 459-464.
- 27. References Continued • Yoder-Wise, P. S. (2007). Leading and managing in nursing (4th ed.). St. Louis: Mosby