Comparison of ecchymosis rates with measurement of automated and manual blood pressures in patients receiving eptifibatide therapy.
OBJECTIVE
Clinicians often avoid the use of automated blood pressure (BP) devices following coronary interventional procedures in the belief that bleeding into the tissue at the cuff site occurs more often with an automated BP device. Research on the incidence of ecchymosis at the BP cuff site with automated and manual BP measurement devices is limited and involved patients on thrombolytic therapy. The purpose of this study was to determine if the type of BP measurement device (automated or manual) affects the incidence of ecchymosis in patients on eptifibatide therapy after coronary interventional procedures.


METHODS
Using a randomized, controlled trial design, BP was measured for 24 hours in consenting post-coronary intervention subjects with a manual BP and automated BP device. Each subject served as his/her own control, with manual and automated BP devices used for BP measurement on opposite arms of each subject. The incidence of complications associated with BP measurement (ecchymosis, hematoma formation, compartment syndrome) was evaluated periodically during the 24-hour study period. Data were analyzed with Student t test and χ analysis, with P < .05 considered significant.


CONCLUSIONS
In 44 post-coronary interventional procedure patients on eptifibatide therapy, ecchymosis occurred in 9% of arms with automated BP measurement and 14% of arms with manual BP measurement during the 24-hour study period. This difference was not statistically significant. No other complications were observed. This study found that the overall incidence of complications from BP measurement was low and not related to whether the device used was an automated or manual BP device in post-coronary interventional procedure patients on eptifibatide therapy. Based on this study and a prior one, the reluctance of clinicians to use automated BP devices in post-procedural coronary intervention patients because of fears of increased tissue bleeding does not appear scientifically justified.
Sharon Hagerbaumer, BSN, RN, PCCN Staff Nurse, Cardiovascular Telemetry Unit, Exempla Saint Joseph Hospital, Denver, Colorado. Jami Ware, ADN, RN, PCCN Shift Coordinator, Cardiovascular Telemetry Unit, Exempla Saint Joseph Hospital, Denver, Colorado. Gayle Hayden, ADN, RN Shift Coordinator, Cardiovascular Telemetry Unit, Exempla Saint Joseph Hospital, Denver, Colorado. Mary Anne Potter Smith, BSN, RN, PCCN-CMC Staff Nurse, Cardiovascular Telemetry Unit, Exempla Saint Joseph Hospital, Denver, Colorado. Candace Duggan, ADN, RN Staff Nurse, Cardiovascular Telemetry Unit, Exempla Saint Joseph Hospital, Denver, Colorado. Wendy Rockey, BSN, RN Clinical Manager, Cardiovascular Telemetry Unit, Exempla Saint Joseph Hospital, Denver, Colorado. Becky McCabe, ADN, RN Staff Nurse, Cardiovascular Telemetry Unit, Exempla Saint Joseph Hospital, Denver, Colorado. Lori Lanier, ADN, RN Staff Nurse, Cardiovascular Telemetry Unit, Exempla Saint Joseph Hospital, Denver, Colorado.
Sharon
S
Hagerbaumer
Jami
J
Ware
Gayle
G
Hayden
Mary Anne
MA
Potter Smith
Candace
C
Duggan
Wendy
W
Rockey
Becky
B
McCabe
Lori
L
Lanier
D000368:Aged; D001795:Blood Pressure Determination / Q000009:adverse effects* / Q000295:instrumentation*; D004438:Ecchymosis / Q000209:etiology*; D000077542:Eptifibatide; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D010455:Peptides / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*
D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D000077542:Eptifibatide