Elsevier

Heart & Lung

Volume 37, Issue 3, May–June 2008, Pages 205-210
Heart & Lung

Issues in cardiovascular nursing
A randomized controlled trial assessing the use of compression versus vasoconstriction in the treatment of femoral hematoma occurring after percutaneous coronary intervention

https://doi.org/10.1016/j.hrtlng.2007.05.008Get rights and content

Background

The aim of this study was to identify the optimal management of femoral hematoma occurring after coronary angiography and intervention. These procedures carry little risk; however, femoral hematoma is a commonly reported complication, which other studies have suggested is under reported. The objective of this study was to compare the current anecdotal standard practice use of compression in the form of sandbag application with local cold-mediated vasoconstriction in the form of cold-pack application as a clinically more effective and well-tolerated treatment of femoral hematoma.

Methods

Patients who developed femoral hematoma with a surface area of ≥30 cm2 after cardiac catheterization were included in the study (n = 50). Participants were randomly allocated to cold-pack therapy (vasoconstriction trial) or to sandbag (compression-control) application and provided consent before the procedure. Each hematoma was measured at 30-minute intervals during a period of 3 hours. Patient and staff satisfaction were also assessed using a questionnaire.

Results

A significant difference was observed between the 2 groups, with vasoconstriction (cold-pack application) being more effective in rate of reduction of haematoma (confidence interval 95% P < .05). The current practice of sandbag therapy does not provide the most clinically effective patient care according to these data.

Conclusions

Cold-pack therapy is not currently recognized as a standard practice to treat this complication, yet it is more effective than compression and acceptable to patients. The expansion of this study would seek to contribute to the implementation of evidence-based practice.

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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