What's Your Position? Strategies for Safely Reaching Patient Comfort Goals After Cardiac Catheterization via Femoral Approach.
BACKGROUND
Patients frequently complain of back pain after cardiac catheterization, and there is a lack of evidence to guide practice regarding patient comfort while maintaining hemostasis at femoral access site after cardiac catheterization.


OBJECTIVE
The aim of this study was to examine if frequent position changes affect a patient's pain level or increase incidents of bleeding in the recovery period after cardiac catheterization.


METHODS
A quasi-experimental pretest/posttest design was used to evaluate a patient's reported pain levels and positioning changes during bed rest period postprocedure. Twenty charts were reviewed to note documentation of patient position, self-reported pain rating related to pain relief goals, and occurrence of bleeding at the procedure site. A survey was conducted to reveal nurse attitudes, knowledge, and beliefs regarding positioning and pain management for patients in the post-cardiac catheterization period. Results from this survey were used to develop education and data collection tools. Education regarding perceived barriers and importance of maximizing activity orders for patient comfort was provided to nursing staff. After nurse education, an additional 20 charts were reviewed to note if increasing frequency of position change affects pain levels reported by patients or if any increased incidence of bleeding was noted with greater frequency of position change.


RESULTS
Data were analyzed using correlation analyses. Greater levels of pain were associated with higher pain ratings (r = 0.796, P < .000). Use of position change only as a comfort measure was negatively associated with pain ratings; in other words, lower patient pain ratings were associated with use of positioning only without addition of medications to address complaint (r = -0.493, P < .023). There was a significant increase in number of pain management goals met from before to after education intervention (P < .046).


CONCLUSIONS
Nurse concern for increased bleeding was found to be the most common barrier for use of position changes for comfort after cardiac catheterization. This initial analysis suggests position changes in conjunction with pain medication are beneficial in managing pain after cardiac catheterization. There was no increase in bleeding or complications reported; however this study had a small sample size, and caution should be used regarding generalization of findings.
Patricia M. Suggs, MSN, RN, PCCN, RN-BC, is Manager of Cardiac & Procedural Nursing at CaroMont Regional Medical Center in Gastonia, North Carolina. Ms Suggs has 23 years of experience working with cardiology patients, the last 9 years in a leadership role on a unit caring for patients undergoing cardiac catheterization. Rebecca Lewis, BSN, RN, PCCN, has been a staff nurse on CVSS at CaroMont Regional Medical Center in Gastonia, North Carolina. Ms Lewis has 19 years of experience working with cardiology patients. The last 10 years working with patients undergoing cardiac catheterization. Ann C. Hart, MSN, RN, NEA-BC, is a part-time faculty member at School of Nursing, University of North Carolina at Charlotte, and a relief shift manager at CaroMont Regional Medical Center in Gastonia, North Carolina. Ms Hart has more than 40 years of nursing experience in clinical setting and as educator. She has served as officer in Sigma Theta Tau International and on the board of the NC Great 100 Nurses. Meredith Troutman-Jordan, PhD, PMHCNS-BC, is an associate professor at University of North Carolina at Charlotte. Dr Troutman-Jordan is an ANCC-certified psychiatric mental health clinical nurse specialist. Sonya R. Hardin, PhD, RN, CCRN, NP-C, is a professor in the College of Nursing at East Carolina University in Greenville, North Carolina. Dr Hardin has more than 35 years of experience working in critical care areas and has experience in managing cardiovascular units.
Patricia M
PM
Suggs
Rebecca
R
Lewis
Ann C
AC
Hart
Meredith
M
Troutman-Jordan
Sonya R
SR
Hardin
D001416:Back Pain / Q000517:prevention & control*; D001510:Bed Rest; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000451:nursing*; D005268:Femoral Vein; D007722:Health Knowledge, Attitudes, Practice; D006487:Hemostasis; D006764:Hospitals, Community; D006801:Humans; D059408:Pain Management / Q000451:nursing*; D010147:Pain Measurement; D056888:Patient Positioning / Q000451:nursing*; D061214:Patient Safety; D011677:Punctures; D011795:Surveys and Questionnaires