Reducing bedrest following arterial puncture for coronary interventional procedures--impact on vascular complications: the BAC Trial.

BACKGROUND: The optimal time for ambulating patients following femoral arterial puncture for percutaneous coronary intervention is unknown. This study was designed to test the hypothesis that reducing time to ambulation from 6 hours to 2 hours would not increase vascular complications. METHODS: In this randomized, controlled, single-center trial, patients were randomly assigned to receive either 2, 4 or 6 hours (control group) of bedrest after hemostasis was achieved at the femoral arterial puncture site. A total of 354 patients, enrolled from March 1997 to October 1998, participated in the study with 299 completing the full protocol. The primary endpoint was the incidence of vascular complications and any resulting interventions or outcomes including surgery, blood transfusion, prolonged length of stay or ultrasound compression. RESULTS: The 2 hour and 4 hour experimental groups were comprised of 99 patients each, while the 6 hour control group was comprised of 101 patients. There were no differences in vascular complications between the groups. A subgroup analysis of patients who received abciximab (n = 43) did not reveal any differences between groups. Only one patient developed a pseudoaneurysm (p = 0.36), requiring surgical repair and a prolonged length of stay. CONCLUSIONS: Patients undergoing femoral arterial puncture for coronary interventional procedures can safely ambulate 2 hours after hemostasis of the puncture site. Patients receiving abciximab as part of their coronary procedure may be able to ambulate as early as 2 hours following hemostasis.

Research-based practice: reducing bedrest following cardiac catheterization.

Patient discomfort with prolonged bedrest following femoral arterial puncture for cardiac catheterization is a significant nursing problem. Safely reducing the time required for supine bedrest could improve patient comfort and reduce nursing care needs. Reducing bedrest also has the potential to improve organizational resource utilization. A review of the literature was conducted and a decision was made to implement 2 hours of bedrest, a significant decrease from the previous practice of 6 hours. Vascular complications were closely monitored in the first 50 patients, as a means of implementing the research-based change in practice. No significant vascular complications occurred and the practice change has expanded to all inpatient and outpatient areas caring for patients undergoing cardiac catheterization. This experience with utilizing research to change practice has created a positive environment for future research-based initiatives.

Intracoronary stents: expanding options for patients with angina.

Cardiovascular disease remains the leading cause of death in canada. It is responsible for 40 per cent of all deaths and is the leading cause of premature death in people aged 35 to 64. In addition, symptoms of coronary disease have a significant impact on the health status of individuals and families, often negatively affecting quality of life and ability to work.

Applying the Stetler-Marram model to a nursing administration problem: a graduate student learning experience.

Research utilization models have not commonly been used in attempts to solve workplace problems using the results of nursing administration research. This paper describes a graduate learning experience in which the Stetler-Marram Research Utilization Model was applied to a fictitious case in nursing administration. In this case, the model was used to develop a research-based intervention to improve job satisfaction in a hospital setting.