Evaluation of feasibility and safety of changing body position after transfemoral angiography:

Evaluation of feasibility and safety of changing body position after transfemoral angiography:

PAGE 106 JOURNAL OF VASCULAR NURSING SEPTEMBER 2016 www.jvascnurs.net

Evaluation of feasibility and safety of changing body position after transfemoral angiography: A randomized clinical trial

Sina Valiee, PhD, Mohammad Fathi, PhD, Nooshin Hadizade, MD, Daem Roshani, PhD, and Parvin Mahmoodi, MS
From t Kurdista Nursing Kurdista Departm Departm Sanand Univers

Corresp Commit Street, S

Funding Kurdista 31229/1

1062-03

Copyrig

Background: Considering the growing number of patients who suffer from cardiovascular and coronary artery disease

and the significant importance of angiography in the diagnosis of coronary artery disease, this study investigated the ef-

fects of position change on the acute complications of coronary angiography.

Methods: This study was a randomized clinical trial. Sixty patients undergoing coronary angiography, which was per-

formed by a single operator were selected by convenience sampling method and were assigned to intervention or control

groups by randomized block design (30 cases in each group). Intervention group patients’ position was changed according

to schedule, whereas patients in the control group remained in the supine position in complete bed rest. At the entrance

hours, 3, 6, 8, and 24 hours after the angiography, patients in both groups were evaluated in terms of vascular complica-

tions, urinary retention, low back pain, groin pain, and comfort. Data were analyzed by repeated measures, Friedman,

Mann–Whitney, chi-square, independent t-test, and Kolmogorov–Smirnov tests with SPSS-22.

Results: The two groups did not show any significant difference in terms of demographic, clinical, and preinterventional

catheterization characteristics (P > 0.05). There was no significant difference with regard to vascular complications

including hematoma (P = 0.149), bleeding (P > 0.01), bruise (P = 0.081), and thrombosis in the two groups of patients

during 5 consecutive reviews. However, there was a significant statistical difference regarding low back pain

(P < 0.001), groin pain (P < 0.001), urinary retention (P = 0.02), and comfort (P < 0.001).

Conclusions: The results of this study showed that changing the positions of patients after angiography based on the

provided program created no change in the incidence of vascular complications (hematoma, bleeding, thrombosis, and

bruise) but resulted in reduced severity of back pain, groin pain, urinary retention, and increased patients’ comfort. (J

Vasc Nurs 2016;34:106-115)

Cardiovascular disease is one of the leading causes of death for women and men of all ethnicities and races,1 and it is ex- pected to remain the most common cause of death in the world until 2020.2 Among heart disease, coronary artery diseases is the most common and life-threatening one.3

he Social Determinants of Health Research Center, n University of Medical Sciences, Sanandaj, Iran; Department, School of Nursing & Midwifery,

n University of Medical Sciences, Sanandaj, Iran; ent of Epidemiology and Biostatistics, Medicine ent, Kurdistan University of Medical Sciences,

aj, Iran; Student Research Committee, Kurdistan ity of Medical Sciences, Sanandaj, Iran.

onding author: Parvin Mahmoodi, MS, Student Research tee, Kurdistan University of Medical Sciences, Pasdaran anandaj, Iran (E-mail: mahmoodi.parvin@muk.ac.ir).

: This work was supported by the Research Council of n University of Medical Sciences (grant number 1035/ 4).

03/$36.00

ht � 2016 by the Society for Vascular Nursing, Inc.

.doi.org/10.1016/j.jvn.2016.05.001

There are different diagnostic methods for assessing coronary artery disease.4 Coronary angiography is the golden standard test to identify the presence and extent of atherosclerotic disease of coronary artery.5 Annually, nearly three million cardiac catheter- izations are done in the United States of America.6 Angiography involves injecting a radiopaque dye into the coronary arteries un- der fluoroscopy which determines the condition of the coronary arteries and the degree of atherosclerosis.7

Although the risks and complications associated with angiog- raphy depends on the patient’s condition, operator’s skill, and judgment, any invasive procedure has some complications asso- ciated with the procedure.5 Coronary angiography can be ac- cessed via the potential arteries included brachial, radial and femoral arteries.7–11 About 95% of angiography is performed via femoral artery.12,13

Access to the heart via femoral artery can be accompaniedwith complications such as arrhythmia, vascular complications (bleeding, hematoma, and thrombosis), injury and myocardial ischemia, coronary artery perforation, hemodynamic collapse, cer- ebrovertebral accident including transient ischemic attack, allergy to contrast media and acute renal failure.14–18 Demonstration of these complications can be divided in two main form of acute and chronic. The former includes hematoma, bleeding, thrombosis, urinary retention, low back pain, and groin pain.5

Studies have shown that to avoid possible complications due to arterial injuries, the current method of treatment after

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angiography in many health care facilities in Iran is to have the patient rest in the supine position with the head angle of zero de- grees for 8–24 hours and keeping 4 kg (8.82 lbs) sandbag on the catheter insertion site for 6 hours,19–21 which has often been conducted based on tradition and experience.19 This insistence on bed rest for patients after coronary catheterization can lead to restlessness, discomfort, and frequent complaint of back and groin pain.11 About 42% of patients who get out of bed after 4 hours of rest experience back pain.24 In addition, 11.4% of pa- tients undergoing this procedure may develop urinary reten- tion.14,25 Back pain, groin pain, and urinary retention leads to the use of analgesic medications and urinary catheterization which are associated with their own specific complications. To avoid complications resulting from the use of analgesic medications and urinary catheterization, nonmedical measures and nursing care are appropriate.10

Development of technology along with procedures requires appropriate medical and nursing care.22,23 Although there is much evidence for medical approach to care, little evidence exists to support the suggestions relating to management areas such as patient’s position, the time of getting out of bed, and the time of removing sandbag which are generally related to the nursing activities territory.9,24-26 A recent literature review showed that caring of patients undergoing cardiac catheterization requires a revision in key areas of nursing care.19,22,25 Abdollahi et al14 (2013) reported that in addition to changes in body position and leaving the bed early, no vascular complications in patients undergoing coronary angiography was seen, whereas urinary retention in the control group was observed. Rezaei-Adaryani et al19 (2009) reported that patients whose positions were switched during the period of bed rest had experiences less fatigue but more comfort and satisfaction in the 3, 6, 8, and 24 hours after arrival to