Issues in cardiovascular nursingA randomized controlled trial assessing the use of compression versus vasoconstriction in the treatment of femoral hematoma occurring after percutaneous coronary intervention
Section snippets
Methods
The study was conducted in a central London National Health Service (NHS) cardiac unit during a period of 18 months. The unit is comprised of an 11-bed acute coronary unit and a 14-bed short stay unit caring for patients undergoing coronary angiography. A total of 518 patients are admitted each year for both elective and emergency coronary PCI. Ethical approval was obtained through the Local Regional Ethics Committee.
The study inclusion criteria were as follows: Any patient >18 years old
Results
The results from all 50 patients recruited were analyzed and the attrition rate during the study was zero. The data were collected by way of repeated measurements of the hematoma over time. These data were subjected to Mann-Whitney U test for nonparametric differing groups. The demographic profile of the study group is listed in Table I.
The results obtained in this study show a significant difference between the trial and control groups. The results indicate that cold-pack therapy produced a
Discussion
In most centers in the United Kingdom and in the United States, the removal of femoral sheaths and the recognition and initial treatment of vascular complications is often a nursing responsibility,8 and yet there is a deficit in evidence-based practice in this treatment area. As the Department of Health in the United Kingdom has encouraged local delivery of cardiac care,13 consistent postprocedural nursing care is of increasing importance.
Cold-mediated vasoconstriction was used to promote
Conclusion
The results of this study suggested that cold-pack treatment for femoral hematoma is a therapy that has potential to improve clinical outcome. There is a growing body of scientific knowledge that underpins this result. Cold-mediated vasoconstriction, in addition to the normal physiologic vasoconstrictive response, seemed to be of benefit in this patient group. Further investigation in this field would be useful, and further multicenter studies would confirm these data. In addition, another
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2023, Journal of Stomatology, Oral and Maxillofacial SurgeryThe effect of the application of cold on hematoma, ecchymosis, and pain at the catheter site in patients undergoing percutaneous coronary intervention
2019, International Journal of Nursing SciencesCitation Excerpt :In addition, the bed rest time after catheter withdrawal and the ambulation time after rest were not found to be effective in bleeding and hematoma [33,34]. It has been reported that the use of a cold pack is more effective in reducing hematomas after bleeding [35]. One strategy to prevent or reduce complications such as bleeding, hematoma, ecchymosis, and pain is the application of cold [36,37].
Initial approach to a bleeding wound on public roads
2018, FMC Formacion Medica Continuada en Atencion PrimariaEuropean Resuscitation Council Guidelines for Resuscitation 2015. Section 1. Executive summary
2015, ResuscitationCitation Excerpt :Do not try to control major external bleeding by the use of proximal pressure points or elevation of an extremity. However it may be beneficial to apply localised cold therapy, with or without pressure, for minor or closed extremity bleeding.867,868 Where bleeding cannot be controlled by direct pressure it may be possible to control bleeding by the use of a haemostatic dressing or a tourniquet (see below).
European Resuscitation Council Guidelines for Resuscitation 2015 Section 9. First aid
2015, ResuscitationCitation Excerpt :The best control of bleeding is to apply direct pressure to the wound where possible. Localised cold therapy, with or without pressure, may be beneficial in haemostasis for minor or closed bleeding in extremities although this is based on in-hospital evidence.83,84 There is no published evidence for the effective use of proximal pressure points to control bleeding.
Part 9: First aid. 2015 International Consensus on First Aid Science with Treatment Recommendations
2015, ResuscitationCitation Excerpt :For the critical outcome of mortality, we identified no evidence. For the critical outcome of hemostasis, we identified very-low-quality evidence (downgraded for risk of bias, indirectness, and imprecision) from 1 RCT104 showing a benefit in the reduction of femoral hematoma formation in post-PCI patients receiving cold pack (vasoconstriction) compared with sandbags (compression). This study enrolled 50 patients and reported a statistically significant reduction in femoral hematoma formation, but no quantitative data were provided to calculate the MD and CI.