This study assessed the effects of reducing the bed rest time to 4 hours after removing the arterial sheet in coronary angioplasty patients. 124 patients were randomly assigned to either leave bed rest after 4 hours (intervention) or 8 hours (control). Results showed no significant differences between the groups in frequency of bleeding or hematoma formation, or average hematoma size. The study concluded that angioplasty patients who are clinically stable can safely leave bed rest after 4 hours.
Intraoperative aortic dissection during cardiac surgery is infrequent, complicating surgical intervention in 0.04 - 1% of cases. Dissections can occur anywhere, most often as a result of direct mechanical damage at the location of the side clamp, site of cannulation of the aorta, or at the site of proximal anastomosis and may manifest as hematoma, bleeding at the cannulation site or bleeding from the proximal anastomoses or aortic suture lines. Delayed diagnosis and treatment can lead to extremely (23-41%) high mortality rate.
Intraoperative aortic dissection during cardiac surgery is infrequent, complicating surgical intervention in 0.04 - 1% of cases. Dissections can occur anywhere, most often as a result of direct mechanical damage at the location of the side clamp, site of cannulation of the aorta, or at the site of proximal anastomosis and may manifest as hematoma, bleeding at the cannulation site or bleeding from the proximal anastomoses or aortic suture lines. Delayed diagnosis and treatment can lead to extremely (23-41%) high mortality rate.
Coronary artery perforation during percutaneous coronaryRamachandra Barik
Percutaneous coronary intervention (PCI) has considerable
efficacy in the treatment of coronary artery disease, but it is
associated with some complications.[1‑4] One of the uncommon
complications of PCI is a coronary artery perforation, with an
incidence rate of 0.2%–0.6%, which may lead to pericardial
effusion and may consequently progress to cardiac tamponade,
myocardial infarction, and death.[1‑8] We herein present a case
of a right coronary artery (RCA) perforation during PCI.
Coronary angioplasty has revolutionized the management of coronary artery disease. It has not ceased to develop to become the reference method of myocardial revascularization. The aim of our study is to evaluate the ultrasound parameters of left ventricular function after coronary angioplasty. This is a prospective analytical study including patients with stable coronary artery disease with a known coronary artery anatomy programmed for coronary angioplasty. Transthoracic echocardiography was performed four hours before and seven days after myocardial revascularization.
Coronary endarterectomy and patch angioplasty for diffuse coronary artery dis...Abdulsalam Taha
CABG may not be sufficient to treat the diffusely diseased coronary arteries. New techniques such as coronary endarterectomy with patch angioplasty may provide a solution.
Six angiographic indicators of large thrombus burden by
Yip and colleagues,depending upon the angiographic morphology are
features indicated “high-burden thrombus formation”:
1. A cut-off pattern of occlusion
2. Accumulated thrombus proximal to the occlusion
3. A reference lumen diameter of the IRA of >4.0 mm
4. An incomplete obstruction with an angiographic thrombus with
the greatest linear dimension more than 3 times the reference
lumen diameter
5. The presence of floating thrombus proximal to the lesion
6. A persistent dye stasis distal to the occlusion
Stent implantation methods for treatment of abdominal aortic aneurysms (AAA)Or Hananel
The objective of this review is to show different types of treatment for abdominal
aortic aneurysms (AAA) - compare and evaluate the effectiveness of the
treatments.
Coronary artery perforation during percutaneous coronaryRamachandra Barik
Percutaneous coronary intervention (PCI) has considerable
efficacy in the treatment of coronary artery disease, but it is
associated with some complications.[1‑4] One of the uncommon
complications of PCI is a coronary artery perforation, with an
incidence rate of 0.2%–0.6%, which may lead to pericardial
effusion and may consequently progress to cardiac tamponade,
myocardial infarction, and death.[1‑8] We herein present a case
of a right coronary artery (RCA) perforation during PCI.
Coronary angioplasty has revolutionized the management of coronary artery disease. It has not ceased to develop to become the reference method of myocardial revascularization. The aim of our study is to evaluate the ultrasound parameters of left ventricular function after coronary angioplasty. This is a prospective analytical study including patients with stable coronary artery disease with a known coronary artery anatomy programmed for coronary angioplasty. Transthoracic echocardiography was performed four hours before and seven days after myocardial revascularization.
Coronary endarterectomy and patch angioplasty for diffuse coronary artery dis...Abdulsalam Taha
CABG may not be sufficient to treat the diffusely diseased coronary arteries. New techniques such as coronary endarterectomy with patch angioplasty may provide a solution.
Six angiographic indicators of large thrombus burden by
Yip and colleagues,depending upon the angiographic morphology are
features indicated “high-burden thrombus formation”:
1. A cut-off pattern of occlusion
2. Accumulated thrombus proximal to the occlusion
3. A reference lumen diameter of the IRA of >4.0 mm
4. An incomplete obstruction with an angiographic thrombus with
the greatest linear dimension more than 3 times the reference
lumen diameter
5. The presence of floating thrombus proximal to the lesion
6. A persistent dye stasis distal to the occlusion
Stent implantation methods for treatment of abdominal aortic aneurysms (AAA)Or Hananel
The objective of this review is to show different types of treatment for abdominal
aortic aneurysms (AAA) - compare and evaluate the effectiveness of the
treatments.
Outcome After Procedures for Retained Blood Syndrome in Coronary SurgeryPaul Molloy
OBJECTIVES:
Incomplete drainage of blood from around the heart and lungs can lead to retained blood syndrome (RBS) after cardiac sur-
gery. The aim of this study was to assess the incidence of and the outcome after procedures for RBS in patients undergoing isolated coronary artery bypass grafting (CABG)-
Open haemorrhoidectomy revisited: the study of 25 casesKETAN VAGHOLKAR
Background: Haemorrhoids continue to be the commonest benign anorectal condition presenting with bleeding and constipation. The presentation may vary depending on the grade of haemorrhoids. Deciding the best therapeutic option is the biggest challenge faced by the attending surgeon in an era where newer therapeutic technologies for treatment continue to evolve. Therefore, revisiting the traditional surgical option of excision and ligation technique for grossly symptomatic piles was evaluated taking into consideration the cost of the procedure. Twenty five consecutive patients of symptomatic grade III and IV haemorrhoids were selected for the study to determine the outcome of the traditional open method (Milligan Morgan technique)
Methods: Twenty five patients after having been checked for fitness for anaesthesia underwent the open method of haemorrhoidectomy under spinal anaesthesia. On admission to hospital a detailed proforma which contained demographic details, and comorbidities was completed. All 25 patients underwent the same procedure by ligation excision technique. Details of operative findings including post-operative outcomes were studied prospectively. Results were evaluated.
Results: Of the 25 patients, one patient developed bleeding in the immediate post-operative period which required relook surgery and undermining of the oozing stump. Four patients required catheterisation for urinary retention. A six month follow up did not reveal recurrence or any sort of discomfort while passing stools.
Conclusions: Open haemorrhoidectomy (Milligan Morgan) continues to be the most optimum method for treatment of symptomatic piles grade III and IV.
our study and experiences we thus conclude that the stapler haemorrhoidopexy is simple and safe procedure. It is a minimally invasive procedure and it is less associated with post-operative pain bleeding and prolapse. It can be done as the day care surgery.
Can read freely here
https://sethiortho.blogspot.com/
A COMPARISON OF RECOMBINANT UROKINASE WITH VASCULAR SURGERY AS INITIAL TREATMENT FOR ACUTE ARTERIAL OCCLUSION OF THE LEGS
For the thrombolysis or peripheral arterial surgery (TOPAS) investigators RCT
The Rochester study -1994
Surgery Vs Thrombolysis for Ischemia of the Lower Extremity (STILE) - 1996
endovascular surgery
Intraoperative Plain Balloon Angioplasty to Augment Creation of Radiocephalic...semualkaira
The native small cephalic vein may be overlooked during radiocephalic Arteriovenous Fistula (AVF) creation due to concerns over failure rates particularly if the diameter is small. However, native access has benefits in patency and infection risk in selected patients over alternatives such as arteriovenous graft or tunneled hemodialysis catheter. The aim of this study was to review the outcomes of intraoperative Plain Balloon Angioplasty (PBA) in patients with small cephalic veins during AVF creation. We evaluated the maturation, primary and secondary patency rate of salvaged arteriovenous fistulae and identified risk factors related to patency rate.
Intraoperative Plain Balloon Angioplasty to Augment Creation of Radiocephalic...semualkaira
The native small cephalic vein may be overlooked during radiocephalic Arteriovenous Fistula (AVF) creation
due to concerns over failure rates particularly if the diameter is
small. However, native access has benefits in patency and infection risk in selected patients over alternatives such as arteriovenous graft or tunneled hemodialysis catheter. The aim of this
study was to review the outcomes of intraoperative Plain Balloon
Angioplasty (PBA) in patients with small cephalic veins during
AVF creation. We evaluated the maturation, primary and secondary patency rate of salvaged arteriovenous fistulae and identified
risk factors related to patency rate.
Intraoperative Plain Balloon Angioplasty to Augment Creation of Radiocephalic...semualkaira
The native small cephalic vein may be overlooked during radiocephalic Arteriovenous Fistula (AVF) creation
due to concerns over failure rates particularly if the diameter is
small. However, native access has benefits in patency and infection risk in selected patients over alternatives such as arteriovenous graft or tunneled hemodialysis catheter. The aim of this
study was to review the outcomes of intraoperative Plain Balloon
Angioplasty (PBA) in patients with small cephalic veins during
AVF creation. We evaluated the maturation, primary and secondary patency rate of salvaged arteriovenous fistulae and identified
risk factors related to patency rate.
Intraoperative Plain Balloon Angioplasty to Augment Creation of Radiocephalic...semualkaira
The native small cephalic vein may be overlooked during radiocephalic Arteriovenous Fistula (AVF) creation
due to concerns over failure rates particularly if the diameter is
small. However, native access has benefits in patency and infection risk in selected patients over alternatives such as arteriovenous graft or tunneled hemodialysis catheter. The aim of this
study was to review the outcomes of intraoperative Plain Balloon
Angioplasty (PBA) in patients with small cephalic veins during
AVF creation. We evaluated the maturation, primary and secondary patency rate of salvaged arteriovenous fistulae and identified
risk factors related to patency rate.
Intraoperative Intrasac Thrombin Injection to Prevent Type II Endoleak After Endovascular Abdominal Aortic
Aneurysm Repair
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
1. Homework Help
https://www.homeworkping.com/
Research Paper help
https://www.homeworkping.com/
Online Tutoring
https://www.homeworkping.com/
click here for freelancing tutoring sites
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093164/
Iran J Nurs Midw ifery Res. 2010 Summer; 15(3): 109–114.
Four hour ambulation after angioplasty is a safe practice method
BACKGROUND:
During the last 3 decades, there were increasing tendency towards angioplasty because of
its benefits. But, this procedure has its acute problems like bleeding and formation of
hematoma in the removal place of the sheet. Based on researchers’ clinical experiences,
patients need a time of 8-12 hours for bed rest after coronary angioplasty. Recognizing
desirable time for bed rest after angioplasty and remove the arterial sheet forms the
foundation of related researches in the world. Getting out of bed soon after angioplasty,
causes more comfortable feelings, less hospitalization period, fewer side effects of
prolonged bed rest and less hospitalization expenses. Regarding less time for bed rest after
angioplasty, the aim of this study was to assess the effect of the time of getting out of bed
after angioplasty on the complications after removing the sheet in coronary angioplasty
patients.
METHODS:
This was an experimental clinical study conducted in one step and two groups. Samples
were included 124 angioplasty patients (62 in each group) who were chosen randomly from
2. the CCU of Shahid Chamran hospital of the Isfahan University of Medical Sciences in 2007.
Data were gathered by observing and evaluating the patients, using a questionnaire and a
checklist. After angioplasty, patients from the intervention group were taken out of bed in 4
hours and patients from the control group were taken out of bed in 8 hours. After taking out
of bed, patients were examined for bleeding and formation of hematoma in the place of
taking out the arterial sheet. Data were analyzed using descriptive and inferential statistics
via SPSS software.
RESULTS:
Results showed no meaningful difference between the two groups after getting out of bed (p
> 0.05) regarding relative frequency of bleeding (p = 0.50), formation of hematoma (p =
0.34) and average diameter of hematoma (p = 0.39).
CONCLUSIONS:
Results of this study showed that reducing the bed rest time to 4 hours after removing the
arterial sheet of size 7 do not increase bleeding and formation of hematoma in the removal
place of the sheet. So, those angioplasty patients who do not have critical clinical condition
and their vital symptoms are stabilized will be able to get out of bed 4 hours after removing
the sheet.
Keywords: Angioplasty, getting out of bed, removing the sheet, femoral arterial sheet, rest
in bed
Other Sections▼
Acute heart attack is a life threatening condition which could be distinguished by formation
of a local necrotic area in myocardium. Every year, about one million and a hundred
thousand Americans face heart attack. So, heart attack is the main reason of death in
America and causes 529,000 deaths every year.1
In the beginning of 20th
century,
cardiovascular diseases were responsible for less than 10% of deaths but by the beginning
of 21st
century, cardiovascular diseases caused half of the deaths in the world and 25% of
the in developing countries.2
In Iran, cardiovascular diseases have turned into an increasing
problem. According to statistics, cardiovascular diseases caused 27% and 37% of deaths in
1979 and 1990, respectively. Then, every year cardiovascular diseases kill 150,000 Iranian
population.3
Until 1997, coronary bypass surgery was the only method for treating coronary
artery diseases. From that time, other methods like balloon holding cutter, stent, and
atherectomy tools were used for repairing coronary artery. Nowadays, between 800
thousands to a million of angioplasties and 400 thousands of coronary bypass surgeries are
being conducted every year.4
3. In the past 3 decades, there was an increasing tendency towards angioplasty because of its
benefit but this procedure has its own acute problems like bleeding and formation of
hematoma in the removal place of the arterial sheet.5
Frequency of side effects of the
removal place of the arterial sheet in femoral artery after angioplasty based on diagnosis
protocol varies between 1.5% to 18% and is related to the size of the sheet, the amount of
prescribed anticoagulant and the length of remaining sheet in the artery.6
Coronary
angioplasty is a nonsurgical method to increase the diameter of atherosclerotic coronary
arteries by using balloon holding cutters. Cutters usually reach the tightened coronary artery
through femoral artery after installing the arterial sheet.7
Leaving bed soon after angioplasty could increase comfortable feelings, lessen
hospitalization time, lessen effects of long bed rest, and lessen the expenses. Supplying a
safe and healthy protocol for the time of leaving bed after angioplasty improves patient’s
comfort and safety. Reduction of bed rest time after procedure makes more patients to be
ready for discharge from hospital. So, it can reduce hospital’s expenses and make room for
treatment of patients with critical conditions.8
Boztosun et al took patients out of bed 2 hours
after removing the artery angioplasty sheet from the skin. In that study, there were 8 cases
(2.3%) who reported bleeding after taking out of bed. Considering the side effects related to
the removal place of the sheet in conducted researches, their study showed that leaving the
bed after 2 hours is a safe method.9
The results of Keeling et al study showed only 1 case
of bleeding (2%) among patients of intervention group (left the bed 4 hours after removing
the sheet) and there was no meaningful difference between them and the control group
(who left the bed 6 hours after removing the sheet) regarding occurrence of
bleeding.10 Based on researchers’ experiences in the CCU on taking care of angioplasty
patients, they need 8-12 hours of bed rest after this procedure; this timing includes the time
of angioplasty, the time that must be passed before removing the sheet from femoral artery,
and the time that must be passed to make sure there are no bleeding and formation of
hematoma.
Reviewing different hospitals’ policies, it could be understood that the desirable time for bed
rest after removing the arterial sheet is not specified. Recognizing desirable time for
patients to rest in bed after angioplasty and removing the arterial sheet in a way that they
could move safely was the basic foundation of related researches; so, that services would
be supplied with high quality and standards. Search for finding a care service based on
observation is one of the most essential steps to create high quality services for patients.
Considering reduction of bed rest time after angioplasty, we decided to conduct an
investigation to assess the effects of time of leaving the bed after removing the arterial
sheet in coronary angioplasty patients.
4. Study’s special aims included the comparison of the following variables between
intervention and control groups following removing the femoral sheet after angioplasty:
relative frequency of occurrence and severity of bleeding, relative frequency of formation of
hematoma and average diameter of hematoma.
Other Sections▼
Methods
This was an experimental random clinical trial conducted in one step and two groups.
Understudied samples were patients hospitalized in the CCU and cardiac ward of Shahid
Chamran hospital of the Isfahan University of Medical Sciences in 2007 to have elective
angioplasty and had inclusion criteria. First, sampling was done using simple sampling
method. Then, they were randomly divided into two groups of intervention (odd admission
numbers) and control (even admission numbers) and this was continued until the number of
samples was enough. Considering other studies, the number of samples required for this
study was considered 124 patients (62 per group). Sampling was done from June to
October, 2007.
Inclusion criteria were as having elective angioplasty, conducting angioplasty through
femoral artery, formation of homeostasis after removing the sheet by pressure of hand,
using the arterial sheet of size 7, normal results of coagulation tests (PT, PTT, and INR)
before angioplasty, the angioplasty done by the same cardiologist, and the patient
agreement to participate in the study. Exclusion criteria included the history of coagulation
and bleeding diseases, the history of surgery on femoral or iliac artery, history of heart
attack or unstable angina during the study, extra-heparin administration during angioplasty,
bleeding or formation of hematoma before removing the sheet or getting out of bed, long
PTT before removing the sheet that delayed the removal, heparin administration after
angioplasty, and unwillingness for getting out of bed or participate in the study.
Data were gathered by observing and evaluating the patients using a two part questionnaire
and a checklist. The first part included 10 questions on demographic data and medical
history and the second part included 39 questions which was the checklist for evaluating the
patient before angioplasty, during angioplasty, at the time of going into the ward, before
removing the femoral arterial sheet, and before and after getting out of bed. Required
evaluation was done using the questionnaire before going for angioplasty. After the
installation of size 7 arterial sheet, all of the samples received the same dose of heparin (72
to 100 units per each kilogram of body weight) during angioplasty to reach the active
coagulation time of 205 to 300 seconds.11
Condition of the place of the sheet leaking of
blood, bleeding, and formation of hematoma, and also dorsal tibial and metatarsus pulse
5. were evaluated before leaving angioplasty ward, after acceptance in CCU, before removal
of the femoral sheet, and after getting out of bed. Controlling the part that included the
arterial sheet was done every 15 minutes for the first 2 hours after angioplasty, and then
every 1-2 hours until the removal of the sheet. After removing the sheet, it was controlled
again every 15 minutes for 3 hours.5
Then, after 24 hours it was checked to see if any
delayed hematoma has been formed after getting out of bed.6
If there were bleeding and/or
formation of hematoma before getting out of bed at any time, the samples were excluded
from the study. For removing the sheet, INR, PTT and PT were controlled 3 hours after
angioplasty. Four hours after angioplasty, a resident removed the sheet in a sterile situation.
Hand pressure was applied for 15 minutes to make homeostasis.12
A pressure dressing was
put on the removal place of the sheet. After the removal of the sheet, patients absolutely
rested for 4 hours in intervention group and 8 hours in control group (after formation of
homeostasis, they put sand bag on the patient for the period they were laid back in a
straight position. In the last hour, they laid in bed while their head was in the position of 30-
45 degrees). Both groups were controlled for bleeding, formation of hematoma, and dorsal
tibial and metatarsus pulse before getting out of bed. If they did not have any vascular
complications, they got out of bed and walked a distance of 3 meters. If there were no
problems, they were allowed to walk for 3 more meters. Then, they were returned to bed for
resting.12
If there was any bleeding after getting out of bed, the interval between getting out
of bed and bleeding and the severity of bleeding based on the reduction of hemoglobin was
measured. For measuring the reduction of hemoglobin, it was controlled 4 hours after the
start of bleeding.13
The severity of bleeding was determined based on reduction of
hemoglobin (mild bleeding: 1-3 grams reduction in one dl, medium bleeding: 3-5 grams
reduction in one dl, severe bleeding: more than 5 grams reduction in one dl).14
Immediate
aids after bleeding were bed rest and pressing the femoral artery with hand. Need of
transfusion or other recommended interventions by physicians were recorded in the
checklist. In the case of formation of hematoma, the interval between the hematoma
formation and getting out of bed and the biggest hematoma diameter in cm were measured
and recorded.
For validity of data gathering tools, content validity method was used. To make the study
reliable, since the skill of cardiologist has an important role in complications after
angioplasty, all of the angioplasty cases that were done by the cardiologist were included in
the study. Required tests were done by two laboratory technicians. All of the tests were
done in the laboratory of Shahid Chamran hospital. In this study, independent variable was
the time of getting out of bed and dependent variables were occurrence and severity of
bleeding and formation and size of hematoma. Gathered data were analyzed using and
descriptive and inferential statistics via SPSS software.
The ethical committee of the Isfahan University of Medical Sciences approved the study.
6. Other Sections▼
Results
Fisher exact test showed that background variables such as gender, age, body mass index
(BMI), the history of high blood pressure, hyperlipidemia, cigarette smoking and diabetes
were not different between the intervention and the control groups.
Considering the first and second aims of the study, only one mild bleeding was seen among
cases. Results of accurate Fisher test with p = 0.50 showed no meaningful difference
between both groups regarding relative frequency of occurrence of bleeding after getting
out of bed. Formation of hematoma was seen in 3.22% in intervention group and in 6.44%
in control group. Results of Fisher exact test with p = 0.34 showed no meaningful difference
between both groups regarding relative frequency of formation of hematoma after getting
out of bed. The average size of hematoma was 2 ± 0 in intervention group and 2.75 ± 1.5 in
control group.
Results of t-student test with t = 1 and p = 0.39 showed no meaningful difference between
both groups regarding the size of hematoma. Results of accurate Fisher test showed no
meaningful difference between both groups considering the size of hematoma. There was
no hematoma bigger than 5 cm in both groups.
Other Sections▼
Discussion
Results of this study showed that taking patients out of bed in 4 hours after removing the
sheet do not increase the occurrence of bleeding and formation of hematoma at the
removal place. So, patients who had elective angioplasty and their vital symptoms are
stabilized can leave the bed 4 hours after removing the sheet. The study of Boztosun et al
showed 7 cases of bleeding during walking (2.1%) and one case of bleeding after walking
(0.3%) that could be controlled using hand pressure. All of their patients left the bed after 2
more hours bed rest and showed no further complications. There were delayed bleeding in
3 patients (0.9%) after 48 hours that could be controlled by hand pressing and bed rest.
New hematoma of about 1-2 cm was formed during the first week in 9 patients (2.6%).
Findings of this study showed that complications of leaving the bed in 2 hours after coronary
intervention with size 6 cutter through femoral artery are acceptable based on other studies’
findings.9
Pollard et al study conducted in two groups (leaving the bed after 2.5 hours and 4.5 hours)
similar to the present study and showed no meaningful difference between the two groups
7. considering bleeding and formation of hematoma. They said it is safe for patents to leave
the bed after 2.5 hours bed rest.15
In the study of Vlasic et al, there were 99 patents in intervention group and 101 patients in
control group. After random dividing, 9 patients (4.7%) showed formation of hematoma, 4
during the bed rest, and 5 after leaving the bed. But, there was no meaningful difference
between the two groups regarding formation of hematoma. Also 3% of patients had
bleeding that could be controlled by applying extrapressure. There was no meaningful
difference between the two groups considering bleeding too.16
In Kleeng et al study, patients were randomly divided into two groups each consisting of 51
patients. Intervention group left the bed after 4 hours and control group left the bed after 6
hours. There was only one case of bleeding (2%) among intervention group. Based on the
results of this study, time of leaving the bed after angioplasty was reduced to 4 hours in the
Medical Center of the University of Virginia.10
Another study by Rosenstein et al was conducted to show the complications of the removal
place. About 1.3% of the group who left the bed sooner than 2 hours and 16% of the group
who left the bed later than 2 hours showed complications related to angioplasty. There was
no case of big hematoma, retroperitoneal bleeding, and required blood transfusion. Results
of this study showed no meaningful difference between the two groups regarding bleeding
and formation of hematoma after leaving the bed.17
In the study of Koch et al, the frequency of occurrence of bleeding was 1.7%. There was
bleeding in 4 patients while leaving the bed and in 1 patient 15 minutes after leaving. Report
of 48-hour follow-up showed big hematoma in 3% of patients which means 9 patients had
hematoma bigger than 5 cm. No need for blood transfusion or vascular reconstructive
surgery was reported. Bleedings could be controlled by bed rest and applying
extrapressure. No case had delayed bleeding or vascular complications. Also, leaving the
bed in 4 hours after angioplasty was safe for patients and did not increase the risk of
bleeding and formation of hematoma in comparison with leaving the bed after 8 hours.5
Patients endure a long-time bed rest during and after angioplasty. This condition is not
tolerable for patients. Given the results of previous studies and the present study,
researchers hope that physicians and nurses consider the recommended time for those
patients with elective angioplasty and stabilized vital symptoms. Also, the researchers hope
that results of this study be used for giving more information to health care personnel who
work with coronary angioplasty patients for teaching students and retrained nurses, so it
could improve patients’ comfort and safety.
The authors declare no conflict of interest in this study.
8. Other Sections▼
References
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