title: Effectiveness of nursing involvement in bedside monitoring and control of coagulation status after cardiac surgery.
abstract: OBJECTIVE
  This study explores: (1) the feasibility of involvement of nursing staff in routine bedside testing of activated clotting time and (2) joint implementation with resident medical staff of a preformulated plan for management of mediastinal bleeding after cardiac surgery.
  
  
  METHODS
  Patients were divided randomly into two groups, an experimental group (n = 108) subjected to ACT testing and management by protocol, and a control group (n = 146) treated by independent medical decisions.
  
  
  RESULTS
  Bleeding, volume of blood replaced, abnormal coagulation profiles and reoperations to control bleeding and its consequences were all reduced in the study group.
  
  
  CONCLUSIONS
  We concluded that bedside measurement of activated clotting time by nursing staff, associated with therapy based on a flow diagram, enhanced the overall management of early mediastinal bleeding after cardiac surgery as compared with independent management decisions by resident medical staff. In addition, the method provided a sensitive and reliable means of detecting and correcting rebound heparinization in the early postoperative period.
authors.affiliation: Alfred Hospital, Prahran, Victoria, Australia.
authors.forename: K M
authors.initials: KM
authors.lastname: Zeler
authors.forename: T J
authors.initials: TJ
authors.lastname: McPharlane
authors.forename: R F
authors.initials: RF
authors.lastname: Salamonsen
mesh_terms: D001803:Blood Transfusion / Q000706:statistics & numerical data; D001810:Blood Volume; D006348:Cardiac Surgical Procedures / Q000451:nursing*; D002985:Clinical Protocols; D003659:Decision Making, Organizational; D003663:Decision Trees; D005240:Feasibility Studies; D006470:Hemorrhage / Q000097:blood / Q000451:nursing* / Q000628:therapy; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D008482:Mediastinum; D008505:Medical Staff, Hospital / Q000458:organization & administration; D008991:Monitoring, Physiologic / Q000451:nursing*; D015403:Nursing Evaluation Research; D009741:Nursing Staff, Hospital / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D011183:Postoperative Complications / Q000097:blood / Q000451:nursing* / Q000628:therapy; D011479:Protamines / Q000627:therapeutic use; D012086:Reoperation / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D014914:Whole Blood Coagulation Time
chemical_list: D011479:Protamines; D006493:Heparin