Objective: This study aimed to develop an algorithm for nursing intervention after percutaneous coronary intervention in order to improve patients’ safety and prevent complications due to percutaneous coronary intervention that has been becoming a common treatment for coronary artery diseases.
M...
Objective: This study aimed to develop an algorithm for nursing intervention after percutaneous coronary intervention in order to improve patients’ safety and prevent complications due to percutaneous coronary intervention that has been becoming a common treatment for coronary artery diseases.
Methods: Related literatures published since 2000 to the end of August, 2014 were searched by through browsing Pubmed, CINAHL, RISS, KISS, National Assembly Library, and google with assistance of librarians. By reviewing such literatures and interviewing nurses, items and paths that were to be used in the algorithm for nursing intervention after percutaneous coronary intervention were drawn and thereby the draft algorithm was developed. This draft algorithm was revised through content validity test held by experts. The suitability of the algorithm for use in clinical practice and bleeding complications, back pain, and discomfort for patients who underwent the treatment upon the algorithm were evaluated after allowing the nurses to directly apply the algorithm to the patients. Final algorithm was determined based on the results of the evaluation performed after clinical application.
Results: Draft algorithm was developed with assistance of 2 critical care advanced practice nurses based on 14 literatures finally chosen through review on related literatures. Validity for algorithm content and paths used in draft algorithm was verified by 25 experts, including cardiology specialists, internal medicine residents, critical care advanced practice nurses, nurses in cardiovascular ICU with their work experience for 5 years or more and nursing professors, who were working in one of 5 university hospitals located in Busan and Gyeongnam area. The items and paths with content validity index less than 0.78 were revised upon experts’ advice. According to the outcome after allowing nurses to apply revised algorithm to 11 patients, suitability on items composing the algorithm was highly rated whereas promptness was lowly rated. Although the subjects (n=11) to whom the algorithm was applied complained less back pain (p=.001) and discomfort (p=.026) compared to the subjects (n=17) to whom the algorithm was not applied, however, no significant difference in bleeding complication was found. The content of the algorithm was to evaluate vital sign, Level of Consciousness, puncture site, and electrocardiography at patients’ arrival at Intensive Care Unit after percutaneous coronary intervention through femoral artery, to evaluate vital sign, puncture site (presence of bleeding complications, abnormality in peripheral circulation), and electrocardiography in every 15 minutes during the first 1 hour upon patients’ arrival, in every 30 minutes during the next 1 hour, and in every hour up until completion of nursing intervention. Furthermore, electrocardiography and cardiac enzyme were to be continuously monitored. Once the introducer sheath was removed, hemostatic procedure was performed by manual compression or using mechanical compression device and 30˚ head elevation was allowed as hemostasis was confirmed. 30˚ head elevation was allowed after checking bleeding or not in case the vascular closure devices were applied following removal of introducer sheath in cardiovascular radiology room. In case that bleeding complication was found upon evaluation for bleeding complications performed after 4 hour absolute bed rest, additional absolute bed rest or additional intervention upon consultation with attending physician was performed. Posture change on the bed was allowed in case no bleeding complication was found.
Conclusion: This study proposed the clinical utilization of the algorithm developed in this study for nursing intervention after percutaneous coronary intervention in future since this algorithm was revealed to reduce back pain and discomfort without increasing bleeding complications at puncture site.
Objective: This study aimed to develop an algorithm for nursing intervention after percutaneous coronary intervention in order to improve patients’ safety and prevent complications due to percutaneous coronary intervention that has been becoming a common treatment for coronary artery diseases.
Methods: Related literatures published since 2000 to the end of August, 2014 were searched by through browsing Pubmed, CINAHL, RISS, KISS, National Assembly Library, and google with assistance of librarians. By reviewing such literatures and interviewing nurses, items and paths that were to be used in the algorithm for nursing intervention after percutaneous coronary intervention were drawn and thereby the draft algorithm was developed. This draft algorithm was revised through content validity test held by experts. The suitability of the algorithm for use in clinical practice and bleeding complications, back pain, and discomfort for patients who underwent the treatment upon the algorithm were evaluated after allowing the nurses to directly apply the algorithm to the patients. Final algorithm was determined based on the results of the evaluation performed after clinical application.
Results: Draft algorithm was developed with assistance of 2 critical care advanced practice nurses based on 14 literatures finally chosen through review on related literatures. Validity for algorithm content and paths used in draft algorithm was verified by 25 experts, including cardiology specialists, internal medicine residents, critical care advanced practice nurses, nurses in cardiovascular ICU with their work experience for 5 years or more and nursing professors, who were working in one of 5 university hospitals located in Busan and Gyeongnam area. The items and paths with content validity index less than 0.78 were revised upon experts’ advice. According to the outcome after allowing nurses to apply revised algorithm to 11 patients, suitability on items composing the algorithm was highly rated whereas promptness was lowly rated. Although the subjects (n=11) to whom the algorithm was applied complained less back pain (p=.001) and discomfort (p=.026) compared to the subjects (n=17) to whom the algorithm was not applied, however, no significant difference in bleeding complication was found. The content of the algorithm was to evaluate vital sign, Level of Consciousness, puncture site, and electrocardiography at patients’ arrival at Intensive Care Unit after percutaneous coronary intervention through femoral artery, to evaluate vital sign, puncture site (presence of bleeding complications, abnormality in peripheral circulation), and electrocardiography in every 15 minutes during the first 1 hour upon patients’ arrival, in every 30 minutes during the next 1 hour, and in every hour up until completion of nursing intervention. Furthermore, electrocardiography and cardiac enzyme were to be continuously monitored. Once the introducer sheath was removed, hemostatic procedure was performed by manual compression or using mechanical compression device and 30˚ head elevation was allowed as hemostasis was confirmed. 30˚ head elevation was allowed after checking bleeding or not in case the vascular closure devices were applied following removal of introducer sheath in cardiovascular radiology room. In case that bleeding complication was found upon evaluation for bleeding complications performed after 4 hour absolute bed rest, additional absolute bed rest or additional intervention upon consultation with attending physician was performed. Posture change on the bed was allowed in case no bleeding complication was found.
Conclusion: This study proposed the clinical utilization of the algorithm developed in this study for nursing intervention after percutaneous coronary intervention in future since this algorithm was revealed to reduce back pain and discomfort without increasing bleeding complications at puncture site.
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