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Running head: EBP

Evidence Based Practice


Cameron P. Verkaik
Ferris State University

EBP

Evidence Based Practice


This study was performed to assess how different methods of heart catheterization
compare in the quality of patient outcomes, specifically associated with complications. The two
methods of heart catheterization in question during this study are first, the use of the femoral
artery and second, the use of the radial artery. In the United States, the femoral artery is the
method of choice by most interventional cardiologists. As technology progresses, smaller
instruments can be used to perform the same procedures, allowing smaller arteries to be accessed
such as the radial artery. The femoral artery is a much larger artery, which produces much more
arterial pressure and therefore, leads to a much greater risk of bleeding complications. One study
showed that two institutions who performed 3,600 cardiac interventional procedures accessed the
femoral artery 85% of the time and the radial artery only 10% of the time (Armendaris, Azzolin,
Alves, Ritter,Moraes, 2008). Contrastingly, the use of the radial artery is becoming more
common across the nation, even though there is some hesitance because the femoral artery
provides better speed and easier repeatability. It also demands less from the physician
performing the procedure (Armendaris et al, 2008). This femoral artery method requires the
patient to be hospitalized in order that hospital staff, nurses, can monitor the access site. Radial
access has the potential to eliminate many of these problems as well as decrease the
complications associated with this type of procedure.
Study Design
This study was designed as a quantitative analysis using a prospective cohort study of the
population group in question, those whom received a heart catheterization over a three month
span from March to May of 2006 (Armendaris et al, 2008). Participants must be greater than the
age of 18 and could be either male or female. Those that qualified were then reviewed for any

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comorbidities which may put them at risk for having this procedure done, such as congestive
heart failure or renal insufficiency. Those whom met these criteria were then interviewed for
demographic data and to determine which medications they were currently taking. This gave the
researchers 199 participants ranging in age from 53 to 75. For those in the study who were going
to be subject to the radial access method, participants were given the Allens study to determine
if there was sufficient ulnar artery slow to the hand. The radial access site was then covered with
a compressive bandage to maintain homeostasis. Those who were involved in the femoral
approach, were given a series of mechanical compression was applied to the puncture site using a
5-kg weight for at least 15 minutes followed by a 2-kg sandbag for no longer than two hours
(Armendaris et al, 2008). Complications were identified according to the Standars studies,
indicating minor complications as, ecchymosis, bruises, urinary retention, and loss of vessel
permeability, and major complications as, aneurysms, pseudo-aneurysms, and hemorrhages
needing blood transfusion (Armendaris et al, 2008, p. 108).
Results of Study
The results of this study showed the radial approach was successful 98% of the time
while the femoral approach was successful 100% of the time. Success is determined by ability to
access the artery. The most common complication associated with the femoral approach was
urinary retention, and the most common complication with the radial approach was vascular
collapse of the radial artery occurring in 8.53% of the patients (Armendaris et al, 2008).
Bruising and ecchymosis were also more prevalent with the radial approach compared to the
femoral approach. Patients who received heart catheterization via the femoral method also
reported more pain than the radial method.

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These noted complications are important for nurses to recognize and monitor closely. As
patient advocates, nursing staff members can make sure that the patient is comfortable. This may
require a nurse to contact the physician to put in an order for pain medication to relieve the stress
and pain applied to a patient who may be on prolonged bed rest. Also, to follow the guidelines
setup by the hospitals protocol for relieving the applied pressure in a timely manner so that
complications do not arise from prolonged arterial restriction of blood flow, such are vascular
collapse. The type of nursing care provided to each group of patients is different. For example,
those who have had the femoral approach are going to be monitored closely to make sure there is
adequate blood flow distal to the puncture site. The patient may also be assessed for back pain
which may indicate internal bleeding or prolonged bed rest. It is important for these patients to
ambulate when able with nursing personnel who can monitor the site. A Foley catheter may also
be needed or bladder scans as urinary retention is much more common in this group of patients.
Education on the importance of laying still is very important. Patients who have experienced the
radial will also be monitored for bleeding and numbness of the hand as it may indicated arterial
occlusion. These patients will be able to move about much more quickly but will need to be
educated on the importance of not using the effected extremity for some time.
Limitations of Study
There are some limitation characteristics to this study. One limiting factor is the
absence of routine verifications of the active coagulation time after interventions (Armendaris et
al, 2008, p.111). This could be an important variable to monitor as it would give a better
indication as to why bleeding may occur for certain cases. The second limitation was a lack of
follow-up with the patient post discharge. Following the patient after the procedure would have

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given better insight into how well the patient progressed after the procedure (Armendaris et al,
2008).
Nursing Diagnosis
One nursing diagnosis associated with this population group would be knowledge deficit
related to site care as evidenced by voiced concern. It is important for the nurse to educate the
patient in proper site care and maintenance to help relieve this anxiety. This may involve
showing them how to wash around the site, and educating them on the signs of infection.
Outcome criteria would be met when anxiety has been decreased, and the patient is able to
verbalize the instructions of site care.
A second nursing diagnosis would be acute pain related to tissue trauma, as evidenced by,
the patient rating their pain at a 7 on a pain rating scale of 1-10. Outcome criteria would be met
when pain is reduced to a level that is tolerable by the patient. Interventions to assist in the relief
of pain may include monitoring pain levels every hour, assisting patient with repositioning
techniques, and administering PRN medications for pain control.
A third nursing diagnosis associated with the population group in question could be
anxiety related to cardiac catheterization procedure. Outcome criteria would involve relieved
anxiety related to the procedure. This may be achieved through education in the risks involved
and the limited chance in complications. It may also be important to educate the patient on the
procedure itself so that they are informed as to what is going to happen. This may also be a good
time to administer to the patient any PRN anti-anxiety medications on the medication list.
Relevance of Study

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This study shows how the medical field is changing and how the role of the nurse is
constantly evolving. It is important for them to keep on their education so that they may be
better able to assist the patient with their needs.

Reference

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Armendaris, M., Azzolin, K., Alves, F., Ritter, S., & de Moraes, M. (2008). Incidence of vascular
complications in patients submitted to percutaneous transluminal coronary angioplasty by
transradial and transfemoral arterial approach. Acta Paulista De Enfermagem, 21(1), 107111. Retrieved from http://www.scielo.br/pdf/ape/v21n1/16.pdf on October 4, 2014

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