Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492006000100008
Jornal Vascular Brasileiro
Original Article

Remoção de introdutor arterial pós-intervenção coronária percutânea: médico residente versus enfermeiro especializado

Arterial sheath removal after percutaneous coronary intervention: resident versus specialized nurse

José Del Carmen Solano; George Cesar Ximenes Meireles; Luciano Mauricio de Abreu; Antonio Artur da Cruz Forte; Marcos Kiyoshi Sumita; Jorge Hideki Hayashi

http://dx.doi.org/10.1590/S1677-54492006000100008 J Vasc Bras, vol.5, n1, p.42-46, 2006
PDF
Downloads: 1
Views: 1701

Resumo

OBJETIVO: Comparar os resultados da retirada de introdutor arterial pelo enfermeiro especializado em Unidade de Hemodinâmica e pelo médico residente em Cardiologia Intervencionista em pacientes submetidos à intervenção coronária percutânea. MÉTODOS: Trata-se de registro prospectivo em 100 pacientes submetidos à intervenção coronária percutânea, no período de setembro a outubro de 2004, divididos em dois grupos: Grupo A (GA) - enfermeiro (n = 48 pacientes) - e Grupo B (GB) - médico residente (n = 52 pacientes). Hematoma pequeno foi definido como inchaço palpável no local da punção menor que 2 cm; hematoma moderado, com 2 a 6 cm de diâmetro; e hematoma grande, maior que 6 cm de diâmetro. A dose de heparina foi de 100 UI/kg. Os introdutores foram retirados após controle do tempo de coagulação ativado (TCA < 180 segundos), e foi realizada compressão manual por 15 minutos. RESULTADOS: A idade dos pacientes foi de 59,54 ± 11,1 anos (GA) e 61,7 ± 10,4 anos (GB), com predomínio do sexo masculino (GA = 75% e GB = 58%). Os introdutores foram 7 French. O tempo de compressão manual foi de 19,4 ± 3,1 minutos no GA e 19,6 ± 3,1 minutos no GB (P = 0,76). Ocorreram oito hematomas no GA (sete pequenos e um moderado) e nove hematomas no GB (sete pequenos e dois moderados), P = não-significante. Os hematomas foram tratados clinicamente, sem complicações. CONCLUSÃO: A retirada de introdutor arterial, após intervenções coronárias percutâneas, pode ser realizada pelo enfermeiro especializado em Unidade de Hemodinâmica ou pelo médico residente em Cardiologia Intervencionista com segurança e sem complicações maiores.

Palavras-chave

Angioplastia transluminal percutânea coronária, enfermagem, capacitação

Abstract

OBJECTIVE: To compare the results of sheath removal by the catheterization lab specialist nurse and by the interventional cardiology resident in patients submitted to a percutaneous coronary intervention. METHODS: Prospective study with 100 patients submitted to percutaneous coronary intervention, from September to October 2004, who were divided into two groups: Group A (GA) - nurse (n = 48) and Group B (GB) - resident (n = 52). Small hematoma was defined as a palpable swelling at the access site measuring less than 2 cm; mild hematoma, from 2 to 6 cm in diameter; and large hematoma when it was larger than 6 cm in diameter. The heparin dose was 100 IU/kg. The sheaths were removed after activated coagulation time control (ACT < 180 seconds) and a 15-minute manual compression was used. RESULTS: Patients' age was 59.54 ± 11.1 (GA) and 61.7 ± 10.4 (GB) years with a predominance of male patients (GA = 75% and GB = 58%). 7F sheaths were used. Manual compression time was 19.4 ± 3.1 min for GA and 19.6 ± 3.1 min for GB (P = 0.76). There were eight hematomas in GA (seven small and one mild) and nine hematomas in GB (seven small and two mild), P = nonsignificant. The hematomas were clinically treated, with no complications. CONCLUSION: Arterial sheath removal, after percutaneous coronary interventions, can be made by the catheterization lab specialist nurse or interventional cardiology resident safely and without major complications.

Keywords

Percutaneous transluminal coronary angioplasty, nursing, training

References

Bertrand ME, Legrand V, Boland J. Randomized multicenter comparison of conventional anticoagulation versus antiplatelet therapy in unplanned and elective coronary stenting: The Full Anticoagulation Versus Aspirin and Ticlopidine (FANTASTIC) study. Circulation. 1998;98:1597-603.

Leon MB, Baim DS, Popma JJ. A clinical trial comparing three antithrombotic-drug regimens after coronary artery stenting. N Engl J Med. 1998;339:1665-71.

Dick RJ, Popma JJ, Muller DW, Burek KA, Topol EJ. In-hospital costs associated with new percutaneous coronary devices. Am J Cardiol. 1991;68:879-85.

Krause PB, Klein LW. Utility of a percutaneous collagen hemostasis device: to plug or not to plug?. Am Coll Cardiol.. 1993;22:1280-2.

Cote AV, Berger PB, Holmes DR, Scott CG, Bell MR. Hemorrhagic and vascular complications after percutaneous coronary intervention with adjunctive abciximab. Mayo Clin Proc. 2001;76:890-6.

Smith SC Jr, Dove JT, Jacobs AK. ACC/AHA guidelines of percutaneous coronary interventions (revision of the 1993 PTCA guidelines): executive summary. J Am Coll Cardiol. 2001;37:2215-39.

Schickel SI, Adkisson P, Miracle V, Cronin SN. Achieving femoral artery hemostasis after cardiac catheterization: a comparison of methods. Am J Crit Care. 1999;8:406-9.

Competência legal do profissional enfermeiro na retirada de cateter introdutor após procedimentos de natureza hemodinâmica [monografia na Internet]. 2001.

Juran NB, Rouse CL, Smith DD, O'Brien MA, DeLuca AS, Sigmon K. Nursing interventions to decrease bleeding at the femoral access site after percutaneous coronary intervention: SANDBAG Nursing Coordinators. Standards of angioplasty nursing techniques to diminish bleeding around the groin. Am J Crit Care. 2000;8:303-13.

Peet GI, McGrath MA, Brunt JH, Hilton JD. Femoral arterial sheath removal after PTCA: a cross-Canada survey. Can J Cardiovasc Nurs. 1995;6:13-9.

Schickel S, Cronin SN, Mize A, Voelker C. Removal of femoral sheaths by registered nurses: issues and outcomes. Crit Care Nurse. 1996;16:32-6.

O'Grady E. Removal of a femoral sheath following PTCA in cardiac patients. Prof Nurse. 2002;17:651-4.

Smith TT, Labriolola R. Developing best practice in arterial sheath removal for registered nurses. J Nurs Care Qual. 2001;16:61-7.

Rubins S, Wiens L, Fingler I, Sawyer T, Garcia-Vargas P, Stovicek Z. Evaluating a change in practice: femoral sheath removal by registered nurses. Can J Cardiovasc Nurs. 1996;7:19-27.

Jones T, McCutcheon H. A randomised controlled trial comparing the use of manual versus mechanical compression to obtain haemostasis following coronary angiography. Intensive Crit Care Nurs. 2003;19:11-20.

Haldemen S, Silva J, Gonzalez C, Carroll DL. Registered nurse sheath removal team: a quality improvement initiative. . 2002.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5dea488c0e88257e152afa9f jvb Articles
Links & Downloads
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections