Nurse-performed venous sheath removal in patients undergoing radiofrequency catheter ablation for atrial fibrillation: a randomised study.

BACKGROUND: Catheter ablation procedures have recently become a widely accepted method for treating cardiac arrhythmias, and referrals for these procedures have been steadily increasing. As a result, it is now common that sheath removal is handled as a nursing procedure. Regardless of who performs the sheath removal, it is important to extract ablation sheaths without any early or late complications. OBJECTIVE: The aim of this randomised study was to determine the safety of sheath extraction after heparin reversal with low-dose protamine sulfate in patients undergoing radiofrequency catheter ablation for atrial fibrillation and whether these sheaths can be safely removed by nurses. METHODS: Eighty-one patients were randomly assigned to either receiving protamine to reverse heparin after an ablation ( n=40) or to the standard protocol without heparin reversal ( n=41). Nurse-led sheath removal was done in the cath lab (protamine group) or on the ward (standard group) as soon as activated partial thromboplastin time dropped below 60 s. All adverse events, groin compression time, immobilisation time and procedure characteristics were recorded. RESULTS: The manual compression time for the standard group was significantly longer than for the protamine group (15.9 ± 2.5 vs. 21.9 ± 3.1 minutes, P<0.001) as well as the total immobilisation time (13.2 ± 2.4 vs. 20.3 ± 3.8 hours, P=0.01). Minor groin haematomas occurred less frequently in the protamine group (4 vs. 12, P=0.02) and the haematomas tended to be smaller (4.1 ± 2.1 vs. 5.2 ± 2.5 cm, P=0.09). No serious adverse events were observed when the femoral sheaths were extracted by specially trained staff nurses. CONCLUSION: Fewer and milder complications and shorter immobilisation times were reported with protamine reversal compared to the conventional method. Staff nurses can safely remove femoral venous sheaths after a radiofrequency ablation for atrial fibrillation.

Nursing and quality of life in patients with atrial fibrillation before and after radiofrequency ablation.

The importance of nursing and patient quality of life is a top concern for medical professionals. Therefore, participation by medical professionals in raising awareness and continuously supporting improvements in nursing care is an essential part of improving patient quality of life. Modern medical techniques and procedures are changing rapidly, particularly in the field of cardiology. This has resulted in changing roles and increased responsibility for nurses and confirms the necessity for changing the perception of nurses relative to their role in the medical environment and to patient care. This paper presents the results from the first phase of a research project and focuses on quality of life and problematic areas associated with the needs of patients with atrial fibrillation before and after radiofrequency catheter ablation. Atrial fibrillation is one of the most common supraventricular arrhythmias. Its incidence in the general population has risen significantly over the last twenty years. The objective of this research was to assess those areas, which are considered by patients to be problematic before therapeutic intervention. The research was realized through a quantitative survey using a modified questionnaire. Results showed that AF reduced the quality of life both physically and psychologically (i.e. increased levels of anxiety and depression). Results also showed that radiofrequency catheter ablation was able to alleviate symptoms associated with AF and was also able to increase patient quality of life.

[Atrial fibrillation ablation: application of nurse methodology]. / Ablación de fibrilación auricular: aplicación de la metodología enfermera.

Ablation of pulmonary veins for treatment of atrial fibrillation involves applying radiofrequency energy wave by a catheter that causes a circumferential lesion to achieve electrical isolation and voltage drop in the interior. It is mainly applied when there is resistance to treatment and recurrence of symptoms affecting the quality of life of patients. The nurse is an important part of the multidisciplinary team who care for patients who undergo this procedure. The provision of comprehensive nursing care should include nursing procedures prior to, during, and after treatment to ensure the careful and systematic quality required. The aims of this article are: to provide specialised knowledge on the procedure of atrial fibrillation ablation, to describe the preparation of the electrophysiology laboratory, analyse nursing care and develop a standardized care plan for patients on whom this procedure is performed using the NANDA (North American Nursing Association) taxonomy and NIC (Nursing Intervention Classification).

Periprocedural pain of radiofrequency ablation for hepatocellular carcinoma.

Although radiofrequency ablation has been accepted as a safe and effective treatment for small hepatocellular carcinoma, there are few studies addressing periprocedural pain. Our study aims were to investigate periprocedural pain and evaluate its related factors. Ninety-nine patients diagnosed as having hepatocellular carcinoma and who underwent radiofrequency ablation were consecutively enrolled. The pain intensity, mental preparation status for radiofrequency ablation, and demographic and clinical characteristics were investigated. We used an 11-point numerical rating scale to assess for pain. Forty-three percent of subjects reported the intensity of periprocedural pain as more than a level of six (severe pain). The longer duration of ablation (r(s) = .29, p = .004), the number of ablations (r(s) = .27, p = .008), higher pain anxiety (r(s) = .42, p < .001), and difficulty sleeping on the previous day (r(s) = .24, p = .019) were factors related to experiencing more severe pain. The major related factors to severe periprocedural pain were the longer duration of ablation and the more anxiety about pain. Clinicians should offer better information to radiofrequency ablation patients regarding pain expectations and carefully consider periprocedural analgesia requirements.

Health-related quality of life in patients with atrial fibrillation undergoing pulmonary vein isolation, before and after treatment.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia and many AF patients experience a significantly impaired health-related quality of life (HRQOL). AF is also associated with a high risk of stroke and death. Many pharmacologic treatments for AF are ineffective and may have adverse effects. New methods, such as pulmonary vein isolation (PVI), have been developed to treat AF. AIMS: The aim of this study was to investigate the HRQOL issues in severe symptomatic AF patients before and after pulmonary vein isolation. METHODS: Forty patients treated with PVI were included of which 36 concluded the study with the self-reported HRQOL questionnaires before and once after PVI. A standardized control group was used. RESULTS: Compared to the control group the HRQOL before PVI was significantly lower in all domains except for bodily pain. The preoperative scores were compared with the scores obtained at the follow-up. All subscales of the SF-36 significantly improved after the PVI except for bodily pain, which remained unaltered. CONCLUSION: HRQOL is improved in AF patients with severe symptoms after PVI intervention.

Pulsed radio frequency energy in the treatment of complex diabetic foot wounds: two cases.

The use of radio waves (pulsed radio frequency energy) has become well accepted in the treatment of chronic wounds. We present 2 cases of complex diabetic foot wounds treated adjunctively with outpatient pulsed radio frequency energy using a solid-state, 27.12 MHz fixed power output radio frequency generator that transmits a fixed dose of nonionizing, nonthermal electromagnetic energy through an applicator pad. This therapy, in combination with offloading, debridement and advanced dressings, resulted in closure of both wounds in approximately 16 weeks.

Caring for women undergoing cardiac ablation.

Radiofrequency cardiac ablation (RFCA) has become the treatment of choice for many cardiac arrhythmias that have not responded to medication. Complications of cardiac ablation include bleeding, thrombosis, pericardial tamponade, and stroke. Many complications are procedure specific, and several complications can be avoided with appropriate nursing care. Quality patient outcomes begin with competent nursing care. Therefore it is vital for a patient undergoing a percutaneous cardiac ablation procedure to receive supportive care and pre- and post-interventional patient education. This article discusses the nursing care of women undergoing RFCA.

High-frequency jet ventilation during radiofrequency ablation: a case report.

High-frequency jet ventilation (HFJV) has been used in emergency airway scenarios and various surgical procedures. Although substantial literature is available regarding HFJV in these situations, there is only 1 publication to date concerning its use for cardiac radiofrequency ablation procedures. The following case study describes a 49-year-old man undergoing radiofrequency ablation in which HFJV was used. This method has been used for these procedures for months in our institution with great success. Its effectiveness is attributed to the lack of significant heart movement as compared with conventional intermittent positive-pressure ventilation, which, in turn, has improved surgical conditions and resulted in decreased procedure times. In this case, a newly introduced in-line circuit filter was used. Impedance to passive exhalation was created after the filter became saturated from the high humidification. This event, its management, and the following discussion on the mechanics of HFJV and its use in radiofrequency ablation procedures make this case an educational value to all anesthesia providers.

Minimally invasive vein therapy and treatment options for endovenous heat-induced thrombus.

Radiofrequency ablation and endovenous laser therapy are types of minimally invasive techniques that have been used in the treatment of chronic venous insufficiency. In both procedures, high-intensity heat via thermal energy is produced and delivered via an endovenous catheter placed in the saphenous vein. This results in changes that therapeutically induce closure of the vein by denaturing the vessel wall with subsequent thrombus formation. Patients undergo ultrasound 48 to 72 hours postprocedure to confirm vessel occlusion and assess for possible extension of thrombus into the deep venous system. Thrombus is frequently visualized with the procedure in the tributaries, the venous dilations, and at times the saphenofemoral junction. In any other setting, thrombus at the saphenofemoral junction would warrant anticoagulation. However, the characteristics, composition, and behavior of endovenous heat-induced thrombus are different than de novo thrombosis. This postprocedure endovenous heat-induced thrombus is considered a normal consequence of the procedure and does not require traditional anticoagulation in most cases, depending on the location.

Surgical approaches for atrial fibrillation.

The Cox Maze procedure, a cardiac intervention that was developed by James Cox, MD, was first performed in 1988 to surgically cure atrial fibrillation. Over the years, changes in techniques of the classic maze were made, culminating in the Cox Maze III procedure, the Gold Standard. Modifications in the original procedure included simplifying the procedure to a minimally invasive approach. As a result of some of these modifications, the initial maze-like series of surgical atrial incisions has been reduced with the use of alternate energy sources that create hyperthermic lesion lines of conduction block that isolate and interrupt the abnormal impulses. The minimize, a minimally invasive thorascopic approach, can be performed off pump, thus avoiding a median sternotomy and cardiopulmonary bypass and cardioplegic arrest intraoperatively and ensuring a shorter, less painful recovery.

Estudo eletrofisiológico e ablação por cateter: o que a Enfermagem precisa saber / Electrophysiologic study and catheter ablation: what the nursing should know

A ablação por cateter é um procedimento invasivo eletrofisiológico que visa eliminar ou obstruir um circuito arritmogênico. Atualmente o Brasil conta com mais de 30 centros eletrofisiológicos nas regiões diversas que desenvolvem rotineiramente a técnica da ablação por radiofreqüência. Neste cenário específico, a presença da enfermeira vem se destacando desde a preparação do paciente até sua orientação para a alta. O objetivo deste artigo é revisar as indicações do estudo eletrofisiológico e da ablação por cateter para o diagnóstico e tratamento das arritmias cardíacas. O detalhamento técnico, as complicações e os cuidados de enfermagem são apresentados.

Electrosurgical burns in pediatric patients undergoing liver resection with saline-enhanced radiofrequency technology.

Use of saline-enhanced radiofrequency (RF) technology reduces blood loss in infants undergoing liver resection. Radiofrequency systems continuously deliver much higher currents for longer periods of time than conventional coagulation instruments and thus increase the risk of complications. Thress infants undergoing liver resection with the newer RF technology at one facility experienced electrosurgical unit (ESU) dispersive pad burns. As a result, an experiment was performed on animal subjects to determine best ESU dispersive pad placement on infants and to gather data on device impedance. Recommendations to prevent burns include central placement of the ESU dispersive pad and activating warming devices only after resection is complete.