Nursing interventions to decrease bleeding at the femoral access site after percutaneous coronary intervention. SANDBAG Nursing Coordinators. Standards of Angioplasty Nursing Techniques to Diminish Bleeding Around the Groin.
BACKGROUND
This trial is the first prospective, multicenter clinical nursing trial conducted to measure the effect of nursing interventions on bleeding at the femoral access site after percutaneous coronary intervention with or without a potent antiplatelet agent given along with heparin and aspirin.


OBJECTIVE
To measure the relationship between nursing interventions and complications at the arterial access site in patients undergoing percutaneous coronary interventions and to recommend a standard of care to minimize bleeding complications.


METHODS
In a descriptive, correlational 4010-patient study, nursing care interventions after coronary procedures were measured. Observed standards of care were assessed, and regression techniques were used to evaluate nursing interventions and the effect of the interventions on bleeding at the access site after percutaneous coronary procedures.


RESULTS
Several significant correlations between nursing interventions and the occurrences of moderate to severe bleeding at the access site were found; however, most interventions had little effect. The most significant factors in decreasing complications at the access site were early removal of the arterial sheath, the type of pressure mechanism used to achieve arterial hemostasis, staffing allocation, and the person and method used to remove the sheath.


CONCLUSIONS
Many nursing interventions after percutaneous coronary intervention have become routine in the absence of clinical outcome data. Most nursing interventions aimed at decreasing bleeding at the vascular access site increase nursing workload but do not significantly affect bleeding in the groin. These results underscore the importance of continued clinical research studies to validate nursing practice on the basis of patients' outcomes.
Juran
N B
NB
Cleveland Clinic Foundation, Ohio, USA.
Rouse
C L
CL
Smith
D D
DD
O'Brien
M A
MA
DeLuca
S A
SA
Sigmon
K
K
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000451:nursing* / Q000592:standards; D015400:Clinical Nursing Research; D004311:Double-Blind Method; D005260:Female; D005263:Femoral Artery; D006470:Hemorrhage / Q000209:etiology / Q000451:nursing* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment / Q000379:methods; D009731:Nursing Audit; D011182:Postoperative Care / Q000379:methods / Q000451:nursing* / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index