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Angiogram: Reducing Back Pain After Sheath removal

Literature review of evidence based literature and practice. Intervention proposal to be studied with integration of findings.

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Angiogram: Reducing Back Pain After Sheath removal

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  1. Reduce Back Pain Related To Laying Supine; Secondary To, Sheath Removal Post Cardiac Catherization LITERATURE REVIEW PRESENTATION JOHN RALPH QUINONES RN GRAND CANYON UNIVERSITY NRS 433V AUGUST 16, 2009 JackQtoo@yahoo.com

  2. Content • Cardiac Catherization (C-CATH) Facts • Evidence-Based Literature (EBL) • Back Pain Post C-CATH & EBL • Proposed Intervention, “Waffle® Mattresses” • Pressure Ulcer Rational & EBL • Research Utilization & Evidence-Based Nursing • Integrated Findings • Proposed Question • References

  3. Cardiac Catherization’s (C-CATH) Facts United States of America Facts • 5 million C-CATH’s per year • Gold standard for cardiac disease • Diagnosis • Evaluation • Treatment Groupings Following Sheath Removal • Manual compression • Mechanical compression • Vascular Closure Device (VCD) • Patches • Suture mediated closure devices • Sealant closure devices • Staple mediated closure devices (Pennsylvania Patient Safety Advisory [PAPSRS], 2007)

  4. Back Pain Post Cardiac Catherization Manual & Mechanical Compression Groups • Laying supine is most uncomfortable part of admission • 6-24 hours required to ensure adequate haemostasis Goals • Reduce patient discomfort through nursing preventions & interventions (Vlasic, 2004)

  5. Analyses & Critical Appraisal of EBL • Groupings very specific to: • Diagnostic or Intervention • Femoral or Radial Access • Non-Emergent C-CATH • Suggests further: • EVB Studies • Meta-Analysis • Submission to Cochrane Collaboration Interventions • Encourage MD to reduce time laying supine according to risk (Vlasic, 2004) • Change positions (Benson, 2004)

  6. Air Overlays, “Waffle® Mattresses” Proposed Intervention • Air Overlays, "Waffle® Mattresses,” placed under patient prior to C-CATH • Primary Intervention is Prevention

  7. Pressure Ulcer Rational • Support surfaces are key factors in pressure ulcer management and prevention(Spahn & Duncan, 2009) • Homeostasis is significantly impaired when blood vessels are crimped by gradient pressure and shear (Spahn & Duncan, 2009)

  8. Analyses & Critical Appraisal of EBL In a review of 218 research articles, cost of treatment ranges from $500 to $40,000 per ulcer. (Hiser, Rochette, & Philbin, et al., 2009) Waffle® Mattress Cost $68.62-$92.78 each Cleans with soap and water

  9. Research Utilization (RU) & Evidence-Based Practice (EBP) RU • Waffle® promotes endothelial circulation • Reduces pressure on skin and pain • Waffle ® Mattress, Cushion, Seat, Boots EBP • Back pain after C-CATH & sheath removal • Waffle ® reduces back pain • Waffle® reduces back pain after C-CATH & sheath removal • Waffle® Mattress & C-CATH policy

  10. Integrated Findings Reducing Stage 1 ulcers will lead to: • Reduced back pain. • Increased patient satisfaction. • Decrease patient cost. • Decrease organization costs. May lead to: • Decrease in complications. • Meta-analysis

  11. Proposed Question • Can Air Overlays known as, “Waffle® Mattresses,” Reduce Back Pain Related To Laying Supine; Secondary To, Sheath Removal Post Cardiac Catherization ?

  12. References • Barbara Hiser, Jana Rochette, Shawna Philbin, et al. 2009. Implementing aPressure Ulcer Prevention Program and Enhancing the Role of the CWOCN: Impact on Outcomes. EHOB Clinicals Independent Evidence Based Studies Supporting the Waffle® Brand Products. Indianapolis, IN: EHOB Retrieved from: http://www.ehob.com/education/clinical.html • Benson G., 2004. Commentary toChanging patients’ position in bed after non-emergency coronary angiography reduced back pain. Evidence-Based Nursing 2004;7:19; doi:10.1136/ebn.7.1.19. BMJ Publishing Group Ltd & RCN Publishing Company Ltd. Retrieved from: http://ebn.bmj.com/cgi/content/full/7/1/19 • Chair S.Y., Taylor-Piliae R.E., Lam G., et al. 2004. Changing patients’ position in bed after non-emergency coronary angiography reduced back pain. Evidence-Based Nursing 2004;7:19; doi:10.1136/ebn.7.1.19. BMJ Publishing Group Ltd & RCN Publishing Company Ltd. Retrieved from: http://ebn.bmj.com/cgi/content/full/7/1/19 • Pennsylvania Patient Safety Advisory (PA PSRS). 2007. Strategies to Minimize Vascular Complications following a Cardiac Catheterization. PA PSRS Patient Saf Advis 2007 Jun;4(2):58-63. Retrieved from: http://www.patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2007/jun4(2)/Pages/58.aspx • Spahn J.G., Duncan C. 2009. Effects of a support surface on homeostasis. EHOB Clinicals Independent Evidence Based Studies Supporting the Waffle® Brand Products. Indianapolis, IN: EHOB Retrieved from: http://www.ehob.com/education/clinical.html • Vlasic W., 2004. An evidence-based approach to reducing bed rest in the invasive cardiology patient population. Evidence- Based Nursing 2004;7:100-101; doi:10.1136/ebn.7.4.100. BMJ Publishing Group Ltd & RCN Publishing Company Ltd. Retrieved from: http://ebn.bmj.com/cgi/content/full/7/4/100?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=angiopl asty&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT • Wensley C.J., Kent B., McAleer M.B., Price S.M., Stewart J.T. 2008. Pain relief for the removal of femoral sheath in interventional cardiology adult patients. Cochrane Database of Systematic Reviews2008, Issue 4. Art. No.: CD006043. DOI: 10.1002/14651858.CD006043.pub2 Retrieved from: http://www.cochrane.org/reviews/en/ab006043.html

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