title: Bed rest duration after sheath removal following percutaneous coronary interventions: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To explore the effect of bed rest duration after sheath removal following percutaneous coronary interventions on the incidence of vascular complications, back pain and urinary problems.
  
  
  BACKGROUND
  According to the literature, the duration of bed rest after sheath removal following percutaneous coronary interventions ranges from 2-24 hours. Several studies have assessed the effect of duration of bed rest on vascular complications, but a clear final conclusion about the exact duration of bed rest has not been reached.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Cochrane Library, MEDLINE, SCOPUS, CINAHL, IranMedex and IranDoc were searched. No language limitation was applied. RCTs that used two different periods for ambulation were included. Two reviewers separately assessed the quality of each included study and extracted the data. Dichotomous outcomes were recorded as odds ratio with 95% confidence interval.
  
  
  RESULTS
  Five studies involving 1115 participants were included in the review. Among them, two studies had three comparison groups. The studies considered a variety of periods as early and late ambulation, ranging from 2-10 hours. Totally, there were no statistically significant differences in the incidence of bleeding, pseudoaneurysm, arteriovenous fistula and urinary problems between early and late ambulation. There was a statistically significant reduction in the risk of haematoma formation at four to six hours of bed rest compared with eight hours of bed rest (odds ratio = 0·37, 95% CI: 0·15, 0·91). Back pain was reported in one study evaluating three hours of bed rest with an odds ratio of 0·45 (95% confidence interval: 0·28, 0·71) when compared with 10 hours of bed rest.
  
  
  CONCLUSIONS
  Early ambulation after percutaneous coronary interventions is safe and feasible; however, the results should be used with caution as the majority of included studies had methodological flaws.
  
  
  CONCLUSIONS
  The results of this study suggest that patients could be ambulated three to four hours after sheath removal following percutaneous coronary interventions and early ambulation dose does not increase the risk of vascular complications, but it moderates back pain occurrence.
authors.affiliation: Nursing and Midwifery Faculty, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mina
authors.initials: M
authors.lastname: Mohammady
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Atoof
authors.forename: Ali Akbari
authors.initials: AA
authors.lastname: Sari
authors.forename: Mitra
authors.initials: M
authors.lastname: Zolfaghari
mesh_terms: D001510:Bed Rest; D002404:Catheterization / Q000009:adverse effects* / Q000451:nursing; D004434:Early Ambulation; D005263:Femoral Artery; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000451:nursing; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*
keywords: ambulation; percutaneous coronary intervention; systematic reviews and meta-analyses