Vascular access complications after cardiac catheterisation: a nurse-led quality assurance program.
BACKGROUND
Vascular access complications may be a cause of discomfort, prolonged hospital stay, and impaired outcomes in patients undergoing cardiac catheterisation.


OBJECTIVE
To assess vascular access complication in our patients with/without the use of closure devices as a first local benchmark for subsequent quality improvement.


METHODS
A nurse-led single-centre prospective survey of all vascular access complications in consecutive patients submitted to cardiac catheterisation during 4 months.


RESULTS
The radial and femoral access were used in 78 (14%) and 470 (83%), respectively, of 564 procedures, and a closure device was used in 136 of the latter. A haematoma (any size) was isolated and uneventful in 9.6% of cases. More severe complications (haemoglobin loss >2 g, need for blood transfusion or vascular repair) occurred in 1.2% of cases, namely: in none of the procedures with radial access, and in 0.4% and 2.4% of femoral diagnostic and interventional coronary procedures, respectively. During complicated (n=40) vs uncomplicated (n=172) transfemoral interventions, the activated coagulation time was 309+/-83 vs 271+/-71 s (p=0.004), but the use of closure devices was similar.


CONCLUSIONS
Severe vascular access complications in our patients were fewer than in most reports, and virtually absent in radial procedures. Vigorous anticoagulation was associated with increased complications in our patients, but closure devices were not. A new policy including both the use of the radial access whenever possible, and a less aggressive anticoagulation regimen during transfemoral interventions will be tested.
Steffenino
Giuseppe
G
Cardiac Catheterisation Unit, Cardiovascular Department, Ospedale S.Croce, Cuneo, Italy. steffenini.g@ospedale.cuneo.it
Dutto
Stefania
S
Conte
Laura
L
Dutto
Monica
M
Lice
Giulietta
G
Tomatis
Marilena
M
Cavallo
Simona
S
Cavallo
Simona
S
Dellavalle
Antonio
A
Baralis
Giorgio
G
LaScala
Eugenio
E
D000368:Aged; D000740:Anemia / Q000097:blood / Q000209:etiology / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods / Q000451:nursing; D000925:Anticoagulants / Q000009:adverse effects; D019985:Benchmarking / Q000458:organization & administration; D001803:Blood Transfusion; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods / Q000451:nursing; D002985:Clinical Protocols / Q000592:standards; D017023:Coronary Angiography; D005260:Female; D005263:Femoral Artery / Q000293:injuries; D006301:Health Services Needs and Demand; D006406:Hematoma / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000451:nursing / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D015403:Nursing Evaluation Research; D011182:Postoperative Care / Q000451:nursing* / Q000592:standards; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D017534:Radial Artery / Q000293:injuries; D012307:Risk Factors; D017749:Total Quality Management / Q000458:organization & administration
D000925:Anticoagulants