Brief Reports

Two versus six hours of bed rest following left-sided cardiac catheterization and a meta-analysis of early ambulation trials☆

To evaluate the safety of early ambulation in patients undergoing transfemoral arterial interventions via ultrasound-guided femoral low angle arterial access technique (FLAT).

A total of 58 patients undergoing 72 transfemoral arterial procedures that underwent an attempt at FLAT for femoral artery cannulation at our institution from November 2014 to July 2015 were retrospectively identified. Technical success was defined as obtaining less than a 35-degree angle of entry through the anterior wall of the common femoral artery. Patients for which a low angle was achieved were ambulated after 2 hours after hemostasis was achieved with manual compression. All patients received out-patient clinic follow-up which included ultrasound examination of the femoral artery. Chart review provided demographic data, pertinent past medical history, procedural information (type of procedure, size of femoral access sheath, time to ambulation), complications related to arterial access and follow up.

Twelve patients were excluded from the study due to inability to analyze ultrasound images. A low angle was achieved in 37 patients (17 men, 20 women; mean age: 58.5 years ± 13.1 [SD]) undergoing 45 procedures who met inclusion criteria for the study, yielding technical success rate of 75%. There was a moderate positive correlation between the access angle and depth of the common femoral artery at the site of puncture (r = 0.45; P < 0.01). All patients were followed up within 2 weeks of the initial procedure in the outpatient clinic. No arterial access-related complications occurred.

Femoral artery cannulation using FLAT followed by manual compression and ambulation after 2 hours appears to be a safe approach.

This review aims to provide an evidence-based argument that time to mobilization can be decreased in patients after femoral approach diagnostic coronary angiogram in patients with a low risk of vascular complications, where a vascular closure device has not been used. Early mobilization will help to decrease or prevent the potential for back pain occurring. A total of 15 studies published from 1996 to 2011 that met the inclusion criteria were identified. Risk ratios and 95% confidence intervals of vascular complications were calculated for all studies, and a meta-analysis was completed.

The results from this study showed no statistically significant difference in vascular complications between the control groups and the early mobilization (out of bed) groups at ≤2, 3, or 4 hr after femoral approach coronary angiogram. Therefore, mobilization after femoral approach coronary angiogram, without deployment of a vascular closure device, may be as safe at 1.5 to 4 hr mobilization as it is at 6 hr and is likely to have a positive benefit of reducing back pain related to lying in bed.

Femoral arterial puncture is the most common method of vascular access for angiography. Because of possible vascular events, all patients are restricted to strict immobilisation and bed rest for 2–24 h, which is accompanied by back pain and discomfort.

To assess the effects of the duration of bed rest after transfemoral catheterisation on the prevention of vascular complications and general discomfort, pain, urinary discomfort and patient satisfaction.

We searched the Cochrane Library, MEDLINE, SCOPUS, CINAHL, Proquest Dissertations, Open SIGLE, Iranmedex and Irandoc.

We included blinded or unblinded randomised controlled trials and quasi-randomised controlled trials that used two different durations of bed rest after angiography before the ambulation was permitted.

Two reviewers separately assessed the quality of each study and extracted the data. We present dichotomous outcomes as odds ratios with 95% confidence intervals (CI) and continuous outcomes as mean differences with 95% CI.

Twenty studies involving a total of 4019 participants with a mean age of 59.5 years were included. The studies considered periods of bed rest ranging from 2 to 24 h, which we compared in three main categories. There were no statistically significant differences between categories in the incidence of bleeding, haematoma, bruising, pseudoaneurysm, thrombus or arteriovenous fistula. Back pain intensity was assessed in four studies. Patients had significantly less back pain after 2–4 h bed rest compared to 6 h bed rest at 2 h (mean difference: −0.70, 95% CI: −1.07, −0.32), 4 h (mean difference: −0.60, 95% CI: −0.96, −0.24) and 6 h of follow-up (mean difference: −3.77, 95% CI: −4.48, −2.92). One study that assessed urinary discomfort reported less urinary discomfort when bed rest lasted 4 h compared to 12–24 h (mean difference: −1.48; 95% CI: −2.37, −0.59). In addition, reduced bed rest time may significantly decrease the costs of hospital care.

This systematic review suggests that patients can be ambulated after 2–3 h following transfemoral catheterisation, and that early ambulation had no significant effect on the incidence of vascular complications and may reduce back pain and urinary discomfort.

To examine the risk of femoral access site complications in patients undergoing carotid stent placement who were treated with a closure device compared with patients who were not treated with a closure device.

A national, multihospital patient database, the Premier Perspective database, was used to identify patients hospitalized for carotid stent placement from 2006–2011. To reduce potential selection bias, a propensity score was generated for each patient using relevant clinical variables. Propensity score adjustment via 1:1 matching was performed on patients who did and did not receive a closure device. Primary outcomes were minor femoral access site complications and major complications requiring procedural intervention. Secondary outcomes included in-hospital mortality, stroke, and blood transfusion.

Among 12,287 patients who underwent carotid stent placement at 217 hospitals, 6,398 (52%) received a closure device on the day of the procedure. After propensity score matching, patients who received a closure device had a lower likelihood of minor access site complications (4.2% vs 5.4%; odds ratio = 0.77; 95% confidence interval, 0.55–0.93; P = .0071) compared with patients who did not receive a closure device; however, this difference was small and likely not clinically relevant. Both groups had a similar risk of major access site complications (P = .32), in-hospital mortality (P = .0520), and stroke (P = .31).

Use of a closure device was not associated with a substantially reduced risk of major adverse events after carotid stent placement and was associated with only a small improvement in minor access site complications.

Assess the safety and efficacy of early ambulation in patients undergoing diagnostic cardiac catheterization via the femoral artery access with 4 and 6 French sheaths.

Early mobilization after diagnostic cardiac catheterization via femoral artery access with 4 and 6 French sheaths can be done safely without any significant vascular complications. Early ambulation has beneficial results on patient comfort and satisfaction and reduces hospital costs.

The current trend is toward early ambulation after diagnostic cardiac catheterization. Nurse practitioners can be leaders in promoting change in health care practice protocols for optimal patient and hospital outcomes.