From SCAI 2012: Up and at ‘em Post-PCI

Las Vegas—Six hours of bed confinement following femoral sheath removal post-PCI is nobody’s idea of a good time, to put it mildly. In medical parlance there is “some discomfort” whereas lay terminology runs more along the lines of uncomfortable, annoying, frustrating, agonizing and, overall, a giant pain in the—well, back more often than not.

Investigators at Mayo Clinic Rochester wondered whether they could halve the bed-rest time from 6 to 3 hours post-PCI. They randomized 249 patients undergoing intervention utilizing 5 or 6 French sheaths to either 3 (n = 127) or 6 hours (n = 122) of bed rest. Manual pressure was applied post-sheath removal; closure devices were not used. All patients received standard anticoagulant/antiplatelet therapy, including GP IIb/IIIa inhibitors.

Three hours post-hemostasis, 30% of all patients verbalized at least once that they were experiencing pain and 28% required analgesics (similar proportions in both groups). However, in the 3- to 6-hour window, 21% expressed pain or discomfort and 16% required analgesics, with most of these being in the 6-hour bed-rest group.

Overall, patients randomized to 6 hours of bed rest reported significantly more pain, whether by the visual analog scale (p = 0.005), Pain Rating Index (p = 0.003), or Present Pain Index (p = 0.015). Patients randomized to just 3 hours of bed rest reported less back pain and less overall discomfort.

Femoral artery sheath site complications post-hemostasis were not increased with the shortened period of bed rest. Overall, six patients developed a hematoma >5 cm. After ambulation, a hematoma >5 cm was observed in one patient in each treatment group. Re-bleeding occurred in two of the patients with 3 hours of bed rest versus one in the 6-hour group (p > 0.99)

First author, Karen T. Warfield, CNS, RN, said, “It is miserable to sit for 6 hours and not move!” Based on the results, she added, “We have changed our practice consistently and all our patients now get 3 hours (bed rest) after hemostasis—and the hemostasis is achieved with manual pressure alone.”

Keywords: Walking, Visual Analog Scale, Femoral Artery, Back Pain, Hematoma, Hemostasis, Bed Rest, Hemorrhage, Pain Measurement, Platelet Membrane Glycoprotein IIb

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