Decreased bed rest post-percutaneous coronary intervention with a 7-French arterial sheath and its effects on vascular complications.

AIMS AND OBJECTIVES: To compare the incidence of femoral access puncture site complications in the control group, who underwent 6 hr of bed rest, with patients in the case group, who underwent 4 hr of bed rest. BACKGROUND: The ideal bed rest length after percutaneous coronary intervention with a 7-French arterial sheath has been investigated by nursing practice. However, in this larger-sheath-size group, best practices have not been determined, and bed rest time continues to vary markedly among institutions. DESIGN: Retrospective study. METHODS: Data were retrieved from the National Cardiovascular Data Registry and electronic health records in this retrospective study. Sample size was 401 patients: 152 case patients with 4-hr bed rest and 249 controls with 6-hr bed rest. Case group data were obtained from 20 May 2013-31 December 2014; and control group data, 15 June 2011-20 May 2013. RESULTS: National Cardiovascular Data Registry event rates were generally low in both groups: Only three patients in each group had a bleeding event within 72 hr (2% vs. 1%) and no patient and only two controls had arteriovenous fistula (0% vs. 1%). Complications documented in the electronic health records with institutional femoral access puncture site complication definitions identified bleeding at the access site in eight case patients (5%) and nine controls (4%). Haematoma at the access site occurred in 21 case patients (14%) and 25 controls (10%). CONCLUSIONS: The practice change of decreasing bed rest from 6-4 hr for patients with 7-French arterial sheaths post-percutaneous coronary intervention was associated with no significant change in femoral access puncture site complications in either National Cardiovascular Data Registry data or institutional electronic health records data. RELEVANCE TO CLINICAL PRACTICE: This introduces expanded evidence of safety in decreasing bed rest length in larger (7-French) arterial sheaths post-percutaneous coronary intervention.

Evaluation of a biofeedback-assisted meditation program as a stress management tool for hospital nurses: a pilot study.

OBJECTIVE: To assess whether a self-directed, computer-guided meditation training program is useful for stress reduction in hospital nurses. DESIGN: We prospectively evaluated participants before and after a month-long meditation program. The meditation program consisted of 15 computer sessions that used biofeedback to reinforce training. Participants were instructed to practice the intervention for 30 minutes per session, four times a week, for four weeks. Visual analogue scales were used to measure stress, anxiety, and quality of life (assessments were performed using Linear Analogue Self-Assessment [LASA], State Trait Anxiety Inventory [STAI], and Short-Form 36 [SF-36] questionnaires). Differences in scores from baseline to the study's end were compared using the paired t test. RESULTS: Eleven registered nurses not previously engaged in meditation were enrolled; eight completed the study. Intent-to-treat analysis showed significant improvement in stress management, as measured by SF-36 vitality subscale (P = .04), STAI (P = .03), LASA stress (P = .01), and LASA anxiety (P = .01). Nurses were highly satisfied with the meditation program, rating it 8.6 out of 10. CONCLUSIONS: The results of this pilot study suggest the feasibility and efficacy of a biofeedback-assisted, self-directed, meditation training program to help hospital nurses reduce their stress and anxiety. Optimal frequency of use of the program, as well as the duration of effects, should be addressed in future studies.

Effect of the combination of music and nature sounds on pain and anxiety in cardiac surgical patients: a randomized study.

BACKGROUND: Postoperative pain and anxiety are common in cardiac surgery patients. Studies have suggested that music can decrease anxiety in hospitalized patients. Primary Study Objective This study focused on the efficacy and feasibility of special music, which included nature sounds, for pain and anxiety. METHODS/DESIGN: In this randomized controlled trial, postoperative cardiovascular surgery patients were randomly assigned to a music group to receive 20 minutes of standard postoperative care and music twice daily on postoperative days 2 through 4 or to a control group to receive 20 minutes of standard care with a quiet resting period twice daily on postoperative days 2 through 4. SETTING: Cardiovascular surgical unit of Saint Marys Hospital, Rochester, Minnesota. PARTICIPANTS: One hundred patients completed the study (music group, n = 49; control group, n = 51). Intervention The music was delivered through CD players in the patients' rooms. PRIMARY OUTCOME MEASURES: Pain, anxiety, satisfaction, and relaxation were evaluated from visual analog scales. RESULTS: Data showed a significant decrease in mean (SD) pain scores after the second session of day 2 for the music group (change, ?1.4 [1.4]) compared with the control group (change, ?0.4 [1.4]) (P = .001). Mean relaxation scores improved more at the first session of day 2 for the music group (change, 1.9 [2.7]) compared with the control group (change, 0.3 [2.9]) (P = .03). The music group also showed lower anxiety and increased satisfaction overall, but these differences were not statistically significant. No major barriers to using the therapy were identified. CONCLUSION: Recorded music and nature sounds can be integrated into the postoperative care of cardiovascular surgery patients. The recordings may provide an additional means for addressing common symptoms of pain and anxiety while providing a means of relaxation for these patients.

Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study.

Integrative therapies such as massage have gained support as interventions that improve the overall patient experience during hospitalization. Cardiac surgery patients undergo long procedures and commonly have postoperative back and shoulder pain, anxiety, and tension. Given the promising effects of massage therapy for alleviation of pain, tension, and anxiety, we studied the efficacy and feasibility of massage therapy delivered in the postoperative cardiovascular surgery setting. Patients were randomized to receive a massage or to have quiet relaxation time (control). In total, 113 patients completed the study (massage, n=62; control, n=51). Patients receiving massage therapy had significantly decreased pain, anxiety, and tension. Patients were highly satisfied with the intervention, and no major barriers to implementing massage therapy were identified. Massage therapy may be an important component of the healing experience for patients after cardiovascular surgery.

Effect of massage therapy on pain, anxiety, and tension in cardiac surgical patients: a pilot study.

OBJECTIVES: To assess the role of massage therapy in the cardiac surgery postoperative period. Specific aims included determining the difference in pain, anxiety, tension, and satisfaction scores of patients before and after massage compared with patients who received standard care. DESIGN: A randomized controlled trial comparing outcomes before and after intervention in and across groups. SETTING: Saint Marys Hospital, Mayo Clinic, Rochester, Minnesota. SUBJECTS: Patients undergoing cardiovascular surgical procedures (coronary artery bypass grafting and/or valvular repair or replacement) (N=58). INTERVENTIONS: Patients in the intervention group received a 20-minute session of massage therapy intervention between postoperative days 2 and 5. Patients in the control group received standard care and a 20-minute quiet time between postoperative days 2 and 5. OUTCOME MEASURES: Linear Analogue Self-assessment scores for pain, anxiety, tension, and satisfaction. RESULTS: Statistically and clinically significant decreases in pain, anxiety, and tension scores were observed for patients who received a 20-minute massage compared with those who received standard care. Patient feedback was markedly positive. CONCLUSIONS: This pilot study showed that massage can be successfully incorporated into a busy cardiac surgical practice. These results suggest that massage may be an important therapy to consider for inclusion in the management of postoperative recovery of cardiovascular surgical patients.

Massage therapy reduces tension, anxiety, and pain in patients awaiting invasive cardiovascular procedures.

OBJECTIVES: (1) To assess the efficacy of a 20 minute massage therapy session on pain, anxiety, and tension in patients before an invasive cardiovascular procedure. (2) To assess overall patient satisfaction with the massage therapy. (3) To evaluate the feasibility of integrating massage therapy into preprocedural practices. Experimental pretest-posttest design using random assignment. Medical cardiology progressive care units at a Midwestern Academic Medical Center. Patients (N=130) undergoing invasive cardiovascular procedures. The intervention group received 20 minutes of hands on massage at least 30 minutes before an invasive cardiovascular procedure. Control group patients received standard preprocedural care. Visual analogue scales were used to collect verbal numeric responses measuring pain, anxiety, and tension pre- and postprocedure. The differences between pre- and postprocedure scores were compared between the massage and standard therapy groups using the Mann-Whitney Wilcoxon's test. Scores for pain, anxiety, and tension scores were identified along with an increase in satisfaction for patients who received a 20-minute massage before procedure compared with those receiving standard care. This pilot study showed that massage can be incorporated into medical cardiovascular units' preprocedural practice and adds validity to prior massage studies.