The impact of timing of ambulation following femoral coronary angiography to prevent vascular complications.

Abstract

Background: Coronary Heart Disease is a major cause of death in Malta and is a major challenge faced by local health authorities. Femoral coronary angiography is the most effective technique for diagnosis and evaluation of coronary artery disease. Following the procedure, manual compression is done on the puncture site and patients are requested to lay in a supine position and rest in order to minimise vascular complications. Study Objective: The purpose of this study was to compare the effects of early ambulation versus late ambulation in preventing local vascular complication post femoral coronary angiography, in relation to the use of variable sheath sizes. Only patients who were subjected to the manual compression technique were included. The PICO question was; 'How does early ambulation compare to late ambulation in preventing vascular complications in adults ' post femoral coronary angiography?' Methodology Overview: An extensive literature search was conducted using two main databases; CINAHL and PubMed. Randomised Control Trials and observational studies were included. Data was subsequently appraised using the CONSORT and STROBE tools. Findings: Sixty seven articles were relevant to this study. Six Randomized Control Trials and four Observational Studies met the inclusion and exclusion criteria. Conclusions: The results revealed that haemostasis and bed rest after angiography are of paramount importance in order to avoid complications. Common vascular complications experienced post femoral angiography included minor/delayed bleeding, haematoma formation, bruising and oozing. The principal conclusion was that reduction of bed rest and promotion of early mobilisation following sheath removal is a safe and effective nursing intervention that ensures prevention of vascular complications and reduces patient discomfort. Early mobilisation may allow earlier patient discharge, and hence more efficient use of hospital beds. Recommendations: Guidelines I protocols regarding optimal duration of bed rest following coronary angiography should be developed and tested for validity and reliability to be implemented. Providing leaflets or publishing a local article are ways of how to upgrade nursing care. Further studies may be carried out to investigate the effect of modification of patients' positioning on vascular complications, back pain and hypertension.