Frequency and timing of activated clotting time levels for sheath removal.
Guidelines currently exist that describe the medical management of patients undergoing percutaneous coronary interventions (PCI), but these guidelines do not include nursing management of the patient post procedure. The nursing staff on an intermediate care unit believed there were numerous and unnecessary activated clotting time (ACT) levels obtained on post PCI patients. The purpose of this study was to identify the most appropriate time to begin analyzing ACT levels. Results from a retrospective chart audit of 44 patients indicated that 3 hours after the last dose of heparin, only 7% of the patients met the criteria of ACT < 150 seconds in order to have their femoral sheaths removed, and 21% of patients had an ACT of < 160 seconds. It is recommended that current standard orders be changed to begin drawing ACT levels at 3 hours post last heparin dose and removing sheaths when ACT is < 160 seconds. This change would save the hospital nearly dollars 5000 in nursing time alone.
Niederstadt
Jennifer A
JA
St. Francis Hospital, Milwaukee, Wis, USA. janiederstadt@covhealth.org
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001291:Attitude of Health Personnel; D015400:Clinical Nursing Research; D002985:Clinical Protocols / Q000592:standards; D017046:Cost Savings; D006470:Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D009731:Nursing Audit; D009741:Nursing Staff, Hospital / Q000191:economics / Q000523:psychology; D011182:Postoperative Care / Q000379:methods / Q000451:nursing; D012189:Retrospective Studies; D013997:Time Factors; D014914:Whole Blood Coagulation Time / Q000191:economics / Q000379:methods* / Q000451:nursing; D016526:Workload