Early Ambulation VS Late Ambulation After Cardiac Catheterization
In the Unites States, cardiovascular disease (CVD) affects nearly 90 million Americans and accounts for approximately 800,000 deaths. It is estimated that every 40 seconds someone in the US dies from CVD (Benjamin EJ, Blaha MJ, Chiuve S, et al. , 2017). Among the various diagnostic procedures that exist between patients with CVD, cardiac catheterizations are quite common to evaluate heart function and diagnose cardiovascular conditions and have a low complication rate (Tongsai, Thamlikitkul, 2012). During this procedure, a catheter is inserted into an artery or vein and threated through the blood vessels until it finally reaches the heart. While the catheter can be inserted through the groin, neck or arm, the femoral arterial puncture is the most common method to gain vascular access (Mohammady, Heidari, Sari, et all. , 2014).
Although this is a generally safe procedure, it is still invasive and poses some risks and possible complications, with vascular events being the most common ones. Because of vascular events having the highest incidence at the groin site, patients who undergo this procedure are under orders of strict immobilization and bed rest on the supine position (Mohammady et all. , 2014). While it is known that a period of rest after a cardiac catheterization is necessary for proper healing and reduction of complications, no universal guidelines have been set for the number of hours the patient must remain on bed rest (Wilcoxson, 2012). Standard practice for rest is between 3-6 hours depending on the facility but can go for as long as 24 hours (Wilcoxson, 2012 & Mohammady et all. , 2014). After cardiac catheterization manual compression is performed on the entry site to achieve hemostasis. This, in conjunction with the average 6 hours of bed rest can lead to patient discomfort and back pain, which in return utilizes hospitals resources, space, time, and can cause delays in hospital discharges (Wilcoxson, 2012).
In hopes of achieving the highest rate of patient satisfaction and optimal use of health care resources, the purpose of this paper is to evaluate the safety and efficacy of early ambulation in comparison with late ambulation following a femoral percutaneous cardiac catheterization. In the meta-analysis by Tongsai and Thamlikitkul (2012), they analyzed five studies that were performed between 2000 and 2011. The studies were selected using multiple electronic databases, hand search and grey literature databases which provided them with an array of articles that were then narrowed to five articles after removing duplicates and assuring that they meet a specific criterion. There were a total of 1854 patients who underwent a femoral percutaneous coronary intervention from the studies. Out of these patients, 1083 of them were assigned to early ambulation (2-4 hours of BR) and 771 were assigned to late ambulation (6-10 hours of BR). After careful examination, the results showed no evidence that patients appointed to early ambulation experienced more complications, in terms of hematoma and bleeding, when compared to those appointed to late ambulation (Tongsai, Thamlikitkul, 2012).
From July 2009 through December 2010, a pilot study in Pennsylvania was conducted to determine the practicality and safety of ambulation at 2 to 3 hours on patients who had just undergone a diagnostic cardiac catheterization (DCC). The researchers used a sample (N=129) of a patient population who met inclusion criteria (Wilcoxson, 2012). After the procedure and once hemostasis was achieved through manual compression, the patients were randomly selected to bed rest of 2, 3 or 6 hours (control). Following the patients’ designated rest time, they were asked to rate their pain and complete a satisfaction survey. In addition, phone calls were made following discharge to assess for any vascular complication including pain, bleeding, or hematoma formation. Using qualitative and quantitative methods, Wilcoxson (2012) confirmed the positive results and low risk of vascular complications in patients who ambulated 2 -3 hours after a DCC. While the research was quite successful, there are a few limitations to this study that are important to address. The study had a small sample of 129 and was occurred at a single facility, and the results should not be applied in patients who are at greater risk of bleeding and those treated with high doses of anticoagulants. Mohammady et all. (2014) used a systematic review to assess the effects, such as vascular complications, comfort level, urinary discomfort, and patient satisfaction, of different durations of bed rest (ranging from 2 to 24 hours) after a femoral cardiac catheterization. Relevant studies were gathered through a computer-aided system including randomized controlled trials as well as quasi-randomized trials whether blinded or unblended (Mohammady et all. , 2014).
There were a total of 4091 participants in the final sample of 20 studies (N=20) included in the review. Studies that used both a shorter (early ambulation) and a longer period (late ambulation) were used as interventions and also for comparison. Once the studies were selected, two reviewers extracted all pertinent data and assessed the quality and risk for any bias. While the research was carefully conducted, the studies varied widely in how they defined early and late ambulation which made comparing the results slightly challenging. Despite the limitations of the research, the qualitative data showed that there was no significant effect on the frequency of vascular complications with early ambulation after a femoral cardiac catheterization (Mohammady et all. , 2014).
In fact, the results in the category of 2-4 hours showed a positive effect on patient satisfaction associated with a lower level of back pain when compared to the category of 6 hours. Moreover, a shorter period of bed rest was correlated with less urinary discomfort by the patients. When taking a look at the articles and their results on the outcomes of early ambulation after a femoral cardiac catheterization, the effects seems to all be consistent in that there is no increased risk for vascular complications in terms of hematoma formation and bleeding. When looking at the studies’ qualitative data, there was not apparent indication that early ambulation was more harmful that late ambulation. Given that early ambulation of patients after a femoral cardiac catheterization contributes to increased patient comfort and satisfaction of care, nurses on the Telemetry floor at Pali Mom should try (unless they already do) to implement this practice.
Not only does this practice contribute overall patient satisfaction, but it also allows for earlier discharge, decreased hospital resources, and an increased availability of free beds that could be used for critical cases and/or new admissions. Because CAD is very prevalent in the country, cardiac catheterizations will remain a common procedure in the United States population. Therefore, if there is a practice that results in considerable benefits for both the patient and the hospital why not introduce a change in practice that can lead to optimal patient care and reduction in facilities’ resources.