Coronary angiography observations: evidence-based or ritualistic practice?
OBJECTIVE
The purposes of this study were to describe the incidence and occurrence of femoral artery bleeding during the first 6 hours after coronary angiography and to determine whether there is a relationship between current postangiogram observation protocols and the detection of complications.


METHODS
This was a prospective descriptive study.


METHODS
The study was conducted in 3 university hospitals in Melbourne, Australia.


METHODS
Subjects included 55 patients representing the complication rate of 1075 patients, mean age 61 years (SD, 12), 69% male.


RESULTS
About 5.1% of patients had 1 or more incidents of bleeding requiring manual compression. In 4.2% of patients, bleeding occurred within 6 hours of angiography. Bleeding occurred a median of 2.02 hours (Q1 = 45 minutes, Q3 = 4.31 hours) after angiography. Patients without pressure bandaging bled a median of 1.32 hours (Q1 = 36.50 minutes, Q3 = 2.59 hours) after angiography. Patients with pressure bandaging bled a median of 4.75 hours (Q1 = 2.25 hours, Q3 = 7.28 hours) after angiography. In 40.6% of cases, bleeding was detected through the patient's call for assistance, and in 59.4% of cases nurses noted bleeding while checking the puncture site. Postcatheter observations were recorded 23.70 (SD, 14.60) minutes before the bleeding incident. There were no significant changes in vital signs, systolic blood pressure (P >.05), diastolic blood pressure (P >.05), or pulse (P >.05) before or during a bleeding episode. All were within normal parameters. No neurovascular assessment anomalies were detected.


CONCLUSIONS
The use of pressure bandaging has a significant effect on the incidence and pattern of bleeding. Routine vital sign measurement has no relevance in detecting local complications after angiography. The most significant complication is bleeding that requires manual compression. Detection is through frequent puncture site observation and patient recognition and communication.
Deakin University School of Nursing, Victoria, Australia.
M
M
Botti
B
B
Williamson
K
K
Steen
D000368:Aged; D001458:Bandages; D016063:Blood Loss, Surgical / Q000451:nursing* / Q000517:prevention & control; D002985:Clinical Protocols / Q000592:standards; D017023:Coronary Angiography / Q000009:adverse effects* / Q000451:nursing*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011897:Random Allocation