Rachel Wilkinson

1
Manual Compression vs. Arterial Puncture Closing
Devices Following Femoral Cardiac
Catheterization

• Rachel Wilkinson
• Brenna Johnson
• Stephanie Ford
• Michelle Giddens

2
Discussion

• Identify the problem
• Review of literature
• Recommended Protocol/Procedure/Intervention
• Suggestions for further study

3
Identifying the Problem

• Coronary Artery Disease is the leading cause of
  death in the United States (Centers for Disease
  Control And Prevention, 2004).
• Cardiac catheterization is one of the most common
  procedures in the United States (Harper, 2007).
• 1.5 million will receive a cardiac
  catheterization this year
• In 2-10 of cases, vascular complications will
  occur
• Oklahoma is ranked 8th in the nation for being
  one of the fattest states.
• 65.1 of Oklahomas population falls in to the
  category of obese or overweight
  (Calorielab,2008).

4
PICO Question

• Which arterial closure method is safer, more
  effective, and causes less vascular complications
  following cardiac catheterization in adultsthe
  use of manual compression or the use of arterial
  puncture closing devices (APCDs)?

5
Identifying the Problem Continued

• PICO
• Population Adult patients18 and older receiving
  femoral cardiac catheterization including all
  genders and ethnicities
• Intervention Arterial puncture closure devices
  (APCDs) to achieve hemostasis
• Comparison Manual pressure to achieve hemostasis
• Outcome Decrease vascular complications

6
Review of Literature

• Arterial puncture closing devices compared with
  standard manual compression after cardiac
  catheterization systematic review and
  meta-analysis (Koreny et al., 2004).
• Systematic review and meta-analysis consisting of
  30 randomized controlled trials
• Measured risk of acquiring hematomas, bleeding,
  developing an arteriovenous fistula, and
  pseudoaneurysm when using APCDs
• Manual compression was determined to be the best
  way to prevent complications following cardiac
  catheterization

7
Review of Literature Continued

• A propensity analysis of the risk of vascular
  complications after cardiac catheterization
  procedures with the use of vascular closure
  devices (Nipun, Matheny, Sepke, 2006).
• Single study comparing manual compression to the
  use of APCDs and the complications associated
  with each after cardiac catheterization
• The results revealed that there was a 58
  reduction in the risk of vascular complication
  when APCDs were used after diagnostic cardiac
  catheterization as opposed to using manual
  compression

8
Review of Literature Continued

• Vascular complications associated with
  arteriotomy closure devices in patients
  undergoing percutaneous coronary procedures A
  meta-analysis (Nikolsky et al., 2004).
• Systematic review and meta-analysis consisting of
  30 studies including 37,066 patients comparing
  the vascular complications that result from
  either manual compression or the use of APCDs
  after cardiac catheterization
• This study concluded that there was no
  significant difference in vascular complications
  when an APCD was used compared to manual
  compression after femoral cardiac catheterization

9
Review of Literature Continued

• Vascular complications with newer generations of
  angioseal vascular closure devices (Applegate et
  al., 2006).
• A single study that compared newer generations of
  a particular type of APCD called Angioseal to
  manual compression and older generations of
  Angioseals after cardiac catheterization
• The results in this study concluded that the
  older and newer generations of Angioseal proved
  to have similar or lower vascular complications
  than that of manual compression

10
Review of Literature Continued

• Risk of local adverse events following cardiac
  catheterization by hemostasis device use and
  gender (Tarvis, et al., 2004).
• Single study that compared complications
  following the use of two types of hemostasis
  devices (sutures and collagen plugs) to manual
  compression
• Complication rates were assessed by gender
• Complications were less common in patients who
  used suture devices or collagen plugs following
  diagnostic cardiac catheterization than those who
  used manual compression
• Complications were more frequent in females than
  in males due to smaller vessel size and/or
  hormonal differences

11
Review of Literature Continued

• Risk of Local Adverse Events following Cardiac
  Catheterization by Hemostasis Device Use -- Phase
  II (Tavris et al., 2005).
• Single study that assessed the risks of vascular
  complications by the type of APCD used compared
  to manual compression
• The results of this article revealed that
  vascular complications were similar between most
  APCDs and manual compression after cardiac
  catheterization
• Women were at twice the risk for any vascular
  complication compared to men

12
Review of Literature Continued

• Predictors of Vascular Complications Post
  Diagnostic Cardiac Catheterization and
  Percutaneous Coronary Interventions (Dumont, C.
  J., Keeling, A. W., Bourguignon, C., Sarembock,
  I. J., Turner, M.,2006).
• This article was a retrospective, descriptive and
  correlational study
• The population studied consisted of 11,110
  patients whose records were retrieved from the
  Clinical Automated Office Solutions database
• Results of this study found that vascular
  complications occurred more often in patients
  whose age was greater than 70 years, being
  female, having hypertension, and renal failure

13
Review of Literature Manual Compression

• Pros

• Cons

• Easy to learn
• Safe and Effective
• No requirement for special equipment

• Painful
• Prolonged mean time to achieve hemostasis (15-20
  minutes)
• Prolonged time to ambulation (4-6 hours)
• Vascular complications
• Nurse arm and hand fatigue
• Longer hospital stay

14
Review of Literature APCDs

• Pros

• Cons

• Costly (190-200)
• May take up to 20 cases for a physician to become
  proficient
• Many nurses have a knowledge deficit in regards
  to APCDs
• Vascular complications

• Shorten the mean time to achieve hemostasis
  (1.46-8.2 minutes)
• Shorten the mean time to ambulation (2.2-4.5
  hours)
• Increases patient comfort
• Decrease hospital stay
• Safe and Effective
• Decreases cost to patients

15
Recommendation

• Our Recommendation
• Nurses to become advocates for APCD use in
  non-high-risk patients
• Multidisciplinary approach to develop a
  high-risk checklist

16
Recommendations Continued

• Our recommendations are based on Kurt Lewins
  Change Theory (Yoder-Wise, 2007)
• Unfreezing
• Experiencing the change
• Refreezing

17
Recommendations Continued

• Unfreezing
• Awareness
• Formal Channels
• High-risk checklist
• In-services
• Informal Channels
• Talking with floor nurses/physicians

18
Recommendations Continued

• Experiencing the change
• Incorporating the use of APCDs
• Praise nursing staff
• Encouraging doctors

19
Recommendations Continued

• Refreezing
• Evaluation
• Formal Channels
• Informal Channels
• Acceptance
• Determined by surveys given to patients, nurses,
  and doctors

20
Suggestions

• Alternative approach to studying the problem
• Chart trends comparing APCDs to manual
  compression

21
Suggestions Continued

• Research Questions
• In APCDs, are the efficacy rates the same for
  using a suture device compared to a collagen
  plug?
• Is standard manual compression better than
  mechanical compression devices such as Femostop
  and C-clamps?

22
Any Questions?
23
References

• Applegate, R.J., Sacrinty, M., Kutcher, M.A.,
  Sanjay, G.K., Talal, B.T., Renato, S.M.,
  William, L.C. (2006). Vascular complication
  with newer generations of angioseal vascular
  closure devices. Journal of Interventional
  Cardiology, 19(1), 67-74.
• Calorielab. (2008). Mississippi is the fattest
  state for 3rd straight year, Colorado still
  leanest, D.C. loses weight. Retrieved March 24,
  2009, from http//calorielab.com/news/2008/07/02/f
  attest- states-2008/

24
References Continued

• Centers For Disease Control And Prevention.
  (2004). Division for Heart Disease and Stroke
  Prevention. Retrieved March 28, 2009, from
  Department of Health and Human Services Web
  site http//www.cdc.gov/dhdsp/state_program/ok.ht
  m
• Dumont, C. J., Keeling, A. W., Bourguignon, C.,
  Sarembock, I. J., Turner, M. (2006).
  Predictors of vascular complications post
  diagnositc cardiac catheterization and
  percutaneous coronary interventions. Dimensions
  of Critical Care Nursing, 25(3),137-142.
• Harper, J. P. (2007). Post-diagnostic cardiac
  catheterization. Journal For Nurses in Staff
  Development , 23(6), 271-276.

25
References Continued

• Koreny, M., Riedmuller, E., Nikfardjam, M.,
  Siostrzonek, P., Mullner, M. (2004). Arterial
  puncture closing devices compared with standard
  manual compression after cardiac
  catheterization Systematic review and
  meta-analysis. American Medical Association,
  291(3), 350-357.
• Nikolsky, E., Roxana, M., Amir, H., Aymong, E.D.,
  Mintz, G.S., Lasic, Z., Negoita, M., Fahy, M.,
  Krieger, S., Moussa, I., Moses, J.W., Stone,
  G.W., Leon, M.B., Pocock, S.J., Dangas, G.
  (2004). Vascular complications associated with
  arteriotomy closure devices in patients
  undergoing percutaneous coronary procedures A
  meta-analysis. Journal of the American College
  of Cardiology, 44(6), 1200-1209.

26
References Continued

• Nipun, A., Matheny, M.E., Sepke, C. (2006). A
  propensity analysis of the risk of vascular
  complications after cardiac catheterization
  procedures with the use of vascular closure
  devices. American Heart Journal, 153(4),
  606-611.
• Tavris, D. R., Dey, S., Albrecht-Gallauresi, B.,
  Brindis, R.G., Shaw, R., Weintraub, W., Mitchel,
  K. (2005). Risk of local adverse events
  following cardiac catheterization by hemostasis
  device use Phase II. The Journal of Invasive
  Cardiology, 17(12), 644-650.
• Tarvis, D. R., Gallauresi, B. A., Rich, S. E.,
  Shaw, R. E., Weintraub, W. S., Brindis, R. G.,
  et al. (2004). Risk of local adverse events
  following cardiac catheterization by hemostasis
  device use and gender. The Journal of Invasive
  Cardiology , 16 (9), 459-464.

27
References Continued

• Yoder-Wise, P. S. (2007). Leading and managing
  in nursing (4th ed.). St. Louis Mosby

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