Logistical, Financial, and Psychological Impact of the COVID-19 Pandemic on Cardiac Catheterization Lab Nurses and Technologists: A U.S. National Survey.

OBJECTIVES: Coronavirus 2019 (COVID-19) significantly impacted cardiac care delivery in a manner that has not been previously experienced in the United States. Attention and resources have focused on physicians, patients, and healthcare systems with little information regarding the effects on nurses and technologists in the cardiac catheterization laboratory (CCL). METHODS: A national, online survey was conducted for nurses and technologists working in the CCL in the United States. The survey was self administered, anonymous, and included 45 questions assessing baseline demographics, logistical changes to workflow and responsibilities, staff preparedness, and mental health. RESULTS: A total of 450 respondents completed the survey, including 283 nurses (63%) and 167 technologists (37%). A total of 349 (78%) were female and mean age range was 41-50 years. Responses indicated that 68% were the primary financial provider for their families, and 74% experienced >75% decrease in case volume despite a low inpatient COVID-19 census (54% of respondents with census <10%). There were high rates of direct care for COVID-19 patients (47%), relocation (45%), lay-off/furloughs of part-time or per diem staff (42%), lay-offs of full-time staff (12%), and decreased work hours (65%). A total of 95% expressed decreased morale with an increase in mental distress, including depression (36%). Predictors of depression included relocation status, staff preparedness, and work hours. CONCLUSION: Logistical changes to CCL staffing resulted in relocation, lay-offs, furloughs, and diminished work hours, with financial and emotional ramifications. Particular attention should be paid to those in large urban hospitals, those at risk for relocation, layoffs, and furloughs, and when preparedness and administrative communication is perceived as poor.

Perfil clínico e epidemiológico de usuários submetidos a cateterismo cardíaco num hospital universitário do Rio de Janeiro / Clinical-epidemiological profile of patients undergoing cardiac catheterization procedures at a university hospital in Rio de Janeiro state / Perfil clínico y epidemiológico de los usuarios sometidos a um cateterismo cardíaco en el hospital universitario de Río de Janeiro

Objective: The study's purpose has been to delineate the clinical-epidemiological profile of patients undergoing cardiac catheterization; furthermore, to propose a management technology to create a database with information of epidemiological relevance. Methods: It is a retrospective study with a quantitative approach, which considers the databases and medical records of 1,890 patients who underwent cardiac catheterization at a hemodynamic unit from April 2014 to April 2016. Microsoft Office Excel® software was used to both organize and analyze the data. CAAE No. 55615616.0.0000.5282. Results: The average age was 61.45 years old. The majority of the assisted population is indicated by the National Regulation System (63%) with the following distribution: (52.86%) male and (47.14%) female. It was identified that 79.5% of the users have high blood pressure. It was found that the current strategy for monitoring the assisted users shows information deficiencies

Objetivo: Traçar o perfil clínico-epidemiológico de usuários submetidos ao cateterismo cardíaco; propor uma tecnologia gerencial para criar um banco de dados com informações de interesse epidemiológico. Método: Estudo quantitativo, retrospectivo de bases de dados e prontuários de 1890 usuários submetidos ao procedimento na unidade de hemodinâmica entre abril/2014 e abril/2016. Utilizou-se o software Microsoft Office Excel® para organização e análise dos dados. CAAE:55615616.0.0000.5282 Resultados: A idade média é de 61,45 anos. A maioria da população atendida é encaminhada pelo Sistema de Regulação (63%) e sua distribuição: (52,86%) masculino e (47,14%) feminino. Identificou-se que 79,5% dos usuários são hipertensos. Verificou-se que a atual estratégia para acompanhamento dos usuários atendidos apresenta falhas nas informações. Conclusão: A consulta de enfermagem com a obtenção de informações relevantes e determinantes para as condutas de enfermagem, contribui para a melhoria do Sistema Único de Saúde. Descritores: Cateterismo cardíaco; Enfermagem; Fatores de risco; Hemodinâmica; Perfil epidemiológico

Nurses' recognition and response to clinical deterioration in the cardiac catheterisation laboratory.

BACKGROUND: Patients presenting to the cardiac catheter laboratory for treatment of unstable acute coronary syndromes (ACS) experience a mismatch in myocardial oxygen supply and demand, causing vital sign abnormalities prior to neurological, cardiac and respiratory deterioration. Delays in detecting clinical deterioration and escalating care increases risk of adverse events, unplanned intensive care (ICU) admission, cardiac arrest, and in-hospital mortality. OBJECTIVES: The objective of the study was to explore how nurses in the cardiac catheter laboratory (CCL) recognise and respond to clinical deterioration in patients with unstable ACS undergoing primary percutaneous coronary intervention (PCI). METHODS: A prospective exploratory descriptive design was used with 30 participants completing 10 written clinical scenarios. Participants scored their level of concern for each physiological cue and then then ranked their preferred immediate response based on the deterioration identified. RESULTS: Hypotension and the presence of pain were the physiological cues of highest concern. The most common responses to clinical deterioration were to increase vital sign assessment to 5-minutely intervals, administer pain relief or provide reassurance. Despite the presence of clinical deterioration fulfilling organisational escalation of care criteria, calling cardiac arrest or rapid response team (RRT) were not commonly selected responses. CONCLUSION: Nurses most commonly use hypotension and the presence of pain to recognise clinical deterioration in patients presenting to the CCL with an unstable ACS. Once clinical deterioration is identified, interventional cardiac nurses delay the escalation of care to the RRT or cardiac arrest team, preferring to implement local nurse initiated interventions.

Desenvolvimento de protótipo de software para orientação de pacientes sobre cateterismo cardíaco e angioplastia de artéria coronária / Software prototype development to the orientation of patients for cardiac catheterism and coronary artery angioplasty

O objetivo geral desse estudo foi desenvolver um protótipo de um software para sistema web e dispositivo móvel para orientação de pacientes sobre Cateterismo Cardíaco e Angioplastia de Artéria Coronária. Tratou-se de estudo de Design Instrucional do tipo Design Centrado no Usuário, aplicado à produção tecnológica para desenvolvimento do protótipo de um software em ambiente web e tecnologia móvel, para consulta de informações sobre Cateterismo Cardíaco e Angioplastia de Artéria Coronária. O estudo foi desenvolvido em quatro etapas, cada qual permitindo o alcance dos objetivos específicos. Para tanto construiu-se o conteúdo sobre esses exames, tendo como base um levantamento bibliográfico, buscando pelas evidências científicas existentes sobre o tema. A primeira versão do conteúdo foi elaborada e apresentada a experts na área de cardiologia para refinamento. Após essa etapa, foi construída a segunda versão do protótipo do software, submetida à avaliação de 30 pacientes que estavam agendados no setor de hemodinâmica de uma instituição hospitalar pública e de ensino e pesquisa para a realização dos procedimentos de Cateterismo Cardíaco e de Angioplastia de Artéria Coronária. Esta etapa de coleta de dados foi realizada em 2018. Após esta avaliação, elaborou-se a terceira versão do protótipo do software, que posteriormente será encaminhada aos procedimentos de ilustração e informatização, para o sistema web. O estudo deixa sua contribuição para a área de cardiologia, para as ciências de saúde, em especial para a Enfermagem e para o avanço tecnológico nas ciências da saúde, por ter apresentado um conteúdo seguro e baseado em evidências científicas, direcionado aos pacientes submetidos a esses complexos exames. Sua contribuição refere-se, também, ao avanço de conhecimento sobre o tema para essa população de indivíduos. Sua aplicação indica que é um instrumento importante para a educação em saúde desses pacientes, podendo suprir as necessidades do pouco conhecimento sobre o Cateterismo Cardíaco e a Angioplastia da Artéria Coronária demonstrada por eles

The general objective of this study was to develop a software prototype to web system and mobile devices for patients orientation about Cardiac Catheterism and Coronary Artery Angioplasty. It was an Instructional Design, much like User Centered Design, applied to the technological production for the software prototype development on web environment and mobile technology, to search information about Cardiac Catheterism and Coronary Artery Angioplasty. The study was developed in four stages, each one allowing the attainment of specific objectives. In order to do that, the examination content was built based on bibliographic research, searching for existent scientific evidences related to the theme. The first content version was elaborated and presented to experts in the cardiology field to its refinement. Following after this stage, a second version of the software prototype was built, submitted to the evaluation of 30 patients scheduled at the hemodynamic sector of a public hospital institution, academics and research, in order to conduct the proceedings of Cardiac Catheterism and Coronary Artery Angioplasty. This stage of data collection was carried out in 2018. After this evaluation, a third version of the software prototype was elaborated, which subsequently will be referred to the illustration and computerisation proceedings, to the web system. The study leaves its contribution to the cardiology field, health sciences, especially to nursing and technological advancements in health sciences, for having presented a safe content, based on scientific evidences, directioned to the patients submitted to these complex examinations. Its contribution also relates to the knowledge advancements about the theme to this individual population. Its application indicates to be an important instrument for patients health education, being able to supply the needs for having little knowledge about Cardiac Catheterism and Coronary Artery Angioplasty, demonstrated by them

Desinformação do usuário e oportunidade para a enfermagem / User disinformation and opportunity for nursing

Objetivo: analisar as repercussões imediatas da ação educativa do enfermeiro realizada na sala de espera da hemodinâmica, voltada aos pacientes e acompanhantes, antes de um procedimento de intervenção cardiovascular. Método: estudo qualitativo, do tipo descritivo, comparativo, ancorado no referencial teórico metodológicoda hermenêutica dialética. Realizado por meio de entrevistas individuais, com roteiro semiestruturado, e de forma coletiva, na sala de espera da hemodinâmica. Resultados: emergiram duas categorias >, >. Conclusão: existem lacunas nas informações sobre cateterismo cardíaco e ausência de um mediador do conhecimento técnico-científico, situação que gera oportunidades para o enfermeiro auxiliar na construção de saberes e troca de experiências.

What's Your Position? Strategies for Safely Reaching Patient Comfort Goals After Cardiac Catheterization via Femoral Approach.

BACKGROUND: Patients frequently complain of back pain after cardiac catheterization, and there is a lack of evidence to guide practice regarding patient comfort while maintaining hemostasis at femoral access site after cardiac catheterization. OBJECTIVE: The aim of this study was to examine if frequent position changes affect a patient's pain level or increase incidents of bleeding in the recovery period after cardiac catheterization. METHODS: A quasi-experimental pretest/posttest design was used to evaluate a patient's reported pain levels and positioning changes during bed rest period postprocedure. Twenty charts were reviewed to note documentation of patient position, self-reported pain rating related to pain relief goals, and occurrence of bleeding at the procedure site. A survey was conducted to reveal nurse attitudes, knowledge, and beliefs regarding positioning and pain management for patients in the post-cardiac catheterization period. Results from this survey were used to develop education and data collection tools. Education regarding perceived barriers and importance of maximizing activity orders for patient comfort was provided to nursing staff. After nurse education, an additional 20 charts were reviewed to note if increasing frequency of position change affects pain levels reported by patients or if any increased incidence of bleeding was noted with greater frequency of position change. RESULTS: Data were analyzed using correlation analyses. Greater levels of pain were associated with higher pain ratings (r = 0.796, P < .000). Use of position change only as a comfort measure was negatively associated with pain ratings; in other words, lower patient pain ratings were associated with use of positioning only without addition of medications to address complaint (r = -0.493, P < .023). There was a significant increase in number of pain management goals met from before to after education intervention (P < .046). DISCUSSION: Nurse concern for increased bleeding was found to be the most common barrier for use of position changes for comfort after cardiac catheterization. This initial analysis suggests position changes in conjunction with pain medication are beneficial in managing pain after cardiac catheterization. There was no increase in bleeding or complications reported; however this study had a small sample size, and caution should be used regarding generalization of findings.

Eficacia del uso de Nobecutan en los vendajes compresivos radiales poscateterismo cardíaco / Impact of Nobecutan use for radial compressive bandage after cardiac catheterization

El cateterismo cardiaco es un procedimiento que consiste en la introducción de un catéter por un acceso arterial (femoral, radial, braquial, cubital) que se lleva hasta el corazón para su estudio anatómico y funcional, grandes vasos y arterias coronarias. En nuestro centro, en la actualidad, se utiliza el acceso arterial radial como primera elección. Cuando finalizamos el estudio se retira el catéter y hay que comprimir el punto de punción por el que hemos realizado la prueba. La hemostasia de la arteria radial tras el cateterismo la realizamos mediante vendaje compresivo con Tensoplast®. Nuestra experiencia previa en el uso de Nobecutan® aerosol en los vendajes compresivos femorales nos hizo extender su uso al nuevo acceso vascular radial. En nuestro estudio, queremos mostrar la eficacia del uso de Nobecutan®, para la protección cutánea de la zona de punción donde se coloca el vendaje compresivo radial. Los resultados muestran una reducción de la lesión dermatológica tras la retirada del vendaje, sobre todo en los pacientes bajo tratamiento antiagregante y en los que hayan presentado lesión dermatológica secundaria al rasurado en la zona de punción (AU)

Cardiac catheterization consists in the introduction of a catheter through a peripheral arterial access (radial, femoral, brachial or cubital approach) directed to the heart, in order to study its anatomy or function, the presence coronary artery disease, and perform coronary interventions if indicated. Radial artery is our first option approach for cardiac catheterization. Once the study is finished, the catheter is removed from the arterial access and the puncture site is compressed to obtain hemostasis with a Tensoplast® compressive bandage. Based in our previous experience with the use of Nobecutan® aerosol in femoral bandage, we decided to extend it to the radial access. Our goal is to explore the Nobecutan® impact in puncture site cutaneous protection, where radial bandage is placed. Results show a reduction in dermatological lesion rate after removing the bandage, especially in patients under antiplatelet therapy and in those with previous dermatological lesion secondary to skin shaving rounding puncture site (AU)

Implicancias de enfermería en accesos radiales y femorales / Nursing implications radial access an femoral preparation of drugs

El cateterismo cardiaco es una técnica de diagnóstico precoz y tratamiento rápido respectivamente, la enfermera debe ser capaz de transmitir al paciente la seguridad necesaria para enfrentar esta técnica para su diagnostico y tratamiento. Para ello debe conocer los cuidados que se derivan de este paciente sometido a cateterismo, la información y educacion sanitaria, imprescindibles para asegurar unos cuidados integrales y un proceso asistencial de calidad, tanto del punto de vista físico como emocional...

Care of the Patient Undergoing Radial Approach Heart Catheterization: Implications for Medical-Surgical Nurses.

Primary treatment for coronary vascular disease focuses on therapeutic lifestyle changes. However, additional medical management or even coronary intervention may be required. Access sites for catheterization include the brachial, radial, and femoral arteries. As an increasing number of providers implement transradial cardiac catheterization, education for nurses is a priority.

The effectiveness of an accessibility-enhanced multimedia informational educational programme in reducing anxiety and increasing satisfaction of patients undergoing cardiac catheterisation.

AIMS AND OBJECTIVES: To evaluate the effectiveness of an accessibility-enhanced multimedia informational educational programme in reducing anxiety and increasing satisfaction with the information and materials received by patients undergoing cardiac catheterisation. BACKGROUND: Cardiac catheterisation is one of the most anxiety-provoking invasive procedures for patients. However, informational education using multimedia to inform patients undergoing cardiac catheterisation has not been extensively explored. DESIGN: A randomised experimental design with three-cohort prospective comparisons. METHODS: In total, 123 consecutive patients were randomly assigned to one of three groups: regular education; (group 1), accessibility-enhanced multimedia informational education (group 2) and instructional digital videodisc education (group 3). Anxiety was measured with Spielberger's State Anxiety Inventory, which was administered at four time intervals: before education (T0), immediately after education (T1), before cardiac catheterisation (T2) and one day after cardiac catheterisation (T3). A satisfaction questionnaire was administrated one day after cardiac catheterisation. Data were collected from May 2009-September 2010 and analysed using descriptive statistics, chi-squared tests, one-way analysis of variance, Scheffe's post hoc test and generalised estimating equations. RESULTS: All patients experienced moderate anxiety at T0 to low anxiety at T3. Accessibility-enhanced multimedia informational education patients had significantly lower anxiety levels and felt the most satisfied with the information and materials received compared with patients in groups 1 and 3. A statistically significant difference in anxiety levels was only found at T2 among the three groups (p = 0·004). CONCLUSIONS: The findings demonstrate that the accessibility-enhanced multimedia informational education was the most effective informational educational module for informing patients about their upcoming cardiac catheterisation, to reduce anxiety and improve satisfaction with the information and materials received compared with the regular education and instructional digital videodisc education. RELEVANCE TO CLINICAL PRACTICE: As the accessibility-enhanced multimedia informational education reduced patient anxiety and improved satisfaction with the information and materials received, it can be adapted to complement patient education in future regular cardiac care.

The evolution of a cardiac catheterization laboratory fellowship.

This column explores the development and implementation of a cardiac catheterization laboratory nursing fellowship at a 600-bed, tertiary-care hospital that is part of a large, multi-facility health system.

Risk factors for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory: a matched case-control study.

BACKGROUND: Side effects of the medications used for procedural sedation and analgesia in the cardiac catheterisation laboratory are known to cause impaired respiratory function. Impaired respiratory function poses considerable risk to patient safety as it can lead to inadequate oxygenation. Having knowledge about the conditions that predict impaired respiratory function prior to the procedure would enable nurses to identify at-risk patients and selectively implement intensive respiratory monitoring. This would reduce the possibility of inadequate oxygenation occurring. AIM: To identify pre-procedure risk factors for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory. DESIGN: Retrospective matched case-control. METHODS: 21 cases of impaired respiratory function were identified and matched to 113 controls from a consecutive cohort of patients over 18 years of age. Conditional logistic regression was used to identify risk factors for impaired respiratory function. RESULTS: With each additional indicator of acute illness, case patients were nearly two times more likely than their controls to experience impaired respiratory function (OR 1.78; 95% CI 1.19-2.67; p = 0.005). Indicators of acute illness included emergency admission, being transferred from a critical care unit for the procedure or requiring respiratory or haemodynamic support in the lead up to the procedure. CONCLUSION: Several factors that predict the likelihood of impaired respiratory function were identified. The results from this study could be used to inform prospective studies investigating the effectiveness of interventions for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory.

Meta-analysis of complication as a risk factor for early ambulation after percutaneous coronary intervention.

PURPOSE: This study systematically examined previous studies on the effect of early ambulation on vascular complications in subjects who had just undergone a percutaneous coronary intervention (PCI), and analyzed the effects of early ambulation on both hemorrhage and hematoma formation at the puncture site. METHODS: Study data were analyzed using the R (version 2.13.1) program. Publication bias was verified via regression analysis, using the logarithm of the odds ratio (OR) and sample size, and a funnel plot using sample size. The risk ratio of the incidence of bleeding and hematoma formation at the puncture site, relative to early ambulation, was confirmed using ORs and the forest plot. RESULTS: The PCI recipients' bed rest time had no significant effect on the risk ratio of hematoma formation (OR = 0.89; 95% CI = 0.68-1.17) nor the incidence of bleeding (OR = 1.14; 95% CI = 0.77-1.7) at the puncture site. CONCLUSIONS: This retrospective study's findings show that early ambulation following PCI had no effect on the incidence of either hematoma formation nor bleeding at the puncture site; however, differences in demographic factors should be considered carefully, in order to avoid interpreting the results too broadly.

Transitioning to transradials: a collaborative process in the cardiac catheterization laboratory.

As transradial approaches to cardiac catheterizations and percutaneous coronary interventions steadily rise in the United States, we reviewed evidence-based studies to compare the radial and femoral approaches to cardiac catheterization. The purpose of this article was to provide an overview of transradial and femoral approaches for cardiac catheterizations and percutaneous coronary interventions, preparation for the procedure, and nursing management of these patients. The strategies used to develop the transition process are also discussed.

Cuidado de enfermería al paciente con ansiedad que va a ser sometido a cateterismo cardíaco / Nursing care for patients with anxiety that will undergo a cardiac catheterization", "_i": "

La enfermedad coronaria es uno de los principales problemas de salud pública a nivel mundial, lo cual ha favorecido el desarrollo de diferentes estrategias de diagnóstico y tratamiento; dentro de éstas, se encuentra el cateterismo cardíaco, procedimiento que en la actualidad se considera como la prueba de oro de la cardiología. Debido al carácter invasivo del cateterismo cardíaco, éste puede generar un impacto emocional importante en el paciente, determinado por respuestas de ansiedad, las cuales pueden acrecentarse por el ambiente hospitalario y las creencias culturales, pero sobre todo, cuando no se recibe una adecuada y oportuna educación sobre todos los cuidados relacionados con éste. Por ello, es esencial el papel que desempeña el profesional de enfermería en la identificación de los niveles de ansiedad de los pacientes a través del uso de instrumentos validados, así como en la generación de intervenciones de enfermería basadas en la comunicación y la educación que reduzcan la ansiedad, lo cual evita la aparición de las complicaciones derivadas de la misma, favorece la satisfacción del paciente y con ello, la calidad de la atención recibida.

Coronary heart disease is a major public health problem worldwide, which has favored the development of different diagnostic and treatment strategies such as the cardiac catheterization, this procedure is now considered as the cardiology proof of gold. Due to the invasive character of the cardiac catheterization, this can generate a significant emotional impact on a patient, determined by his responses of anxiety, this aspect can increase by the hospital environment and cultural beliefs of the procedure, but especially when patient do not receive adequate and timely education about the procedure and all care related to it. It is therefore essential the role of the nurse to identify the anxiety levels of patients through the use of validated instruments and the generation of nursing interventions based on communication and education for reducing anxiety, and prevent the occurrence of complications arising from this, promoting patient satisfaction and thus the quality of care.