title: Comparison of Head Elevation Protocols Following Femoral Artery Sheath Removal After Coronary Angiography.
abstract: OBJECTIVE
  To compare 2 standard protocols for head elevation following removal of a femoral artery sheath after coronary angiography and their effects on bleeding complications and reported levels of back pain. One protocol involved flat supine bed rest; the other allowed progressive head elevation.
  
  
  METHODS
  A prospective comparative study of 80 adult patients undergoing coronary angiography via the femoral approach. The Numeric Rating Scale was used as the measure of reported pain.
  
  
  RESULTS
  No bleeding complications occurred in either group. Both groups had very low mean pain scores. Repeated-measures analysis demonstrated that the experience of pain differed significantly over time by location (F5,70 = 3.864, P = .004), with a notable decrease in pain scores more than 1 hour after sheath removal at the location that used the progressive head elevation protocol. Patients' satisfaction scores after discharge did not differ significantly between the 2 groups. Patients with a history of chronic back pain had consistently higher pain scores, but those pain scores did not differ significantly by location (or protocol).
  
  
  CONCLUSIONS
  It appears that using a progressive head-elevation protocol within the first 3 hours after diagnostic angiography is not associated with an increased risk of bleeding complications at the access site and warrants further exploration in the mitigation of back pain associated with prolonged supine bed rest.
authors.affiliation: Nancy C. Olson is an advanced practice nurse/educator, Cardiovascular Services, Sarasota Memorial Health Care System, Sarasota, Florida. nancy-olson@smh.com.
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Olson
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D015331:Cohort Studies; D017023:Coronary Angiography / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D020878:Device Removal; D017558:Elective Surgical Procedures; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control; D056888:Patient Positioning / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment; D013997:Time Factors