Vascular access complications after interventional and structural procedures: Prospective observational cohort study to guide contemporary nursing practice
Notice bibliographique
Résumé
Abstract Background The rapid emergence of novel interventional and structural technology and procedural approaches has significantly impacted cardiovascular nursing practice in cardiac catheterisation laboratories and cardiac units. In addition to complex percutaneous coronary interventions (PCI), femoral arterial and/or venous access is utilised for transcatheter valve replacement or repair, congenital heart disease interventions, and electrophysiology procedures. Historical evidence that guided practice in the early days of coronary angiography and PCI is no longer sufficient or pertinent to this new clinical context to adequately inform cardiovascular nursing practice. Methods Direct care nurses initiated the conduct of a prospective observational cohort study in a large tertiary care hospital in the setting of a practice-based research competition that aims to strengthen nurses’ involvement in hospital-based research. We aimed to describe the incidence of vascular access complications, explore associated factors contributing to failed vascular haemostasis, and assess the impact of bleeding events on nursing workload. Results We recruited 108 participants who underwent diverse invasive procedures using a femoral vascular access, including transcatheter valve replacement or repair (n=62, 57.4%), coronary angiography and/or PCI (n=26, 24.1%) and electrophysiology procedure (n=10, 9.3%). In this cohort, 30 patients (27.8%) sustained at least 1 bleeding event, with a total of 52 events reported. Events were described as a minor complication (i.e., "oozing vascular site, n=18, 34.6%), involving active bleeding from the side (n=22, 42.3%) or a contained hematoma (n=4, 7.7%). Associated factors to the incidence of vascular access complication included first ambulation (n=10), elimination during bedrest (n=10) and excessive patient movement and/or experience of pain/discomfort on bedrest (n=6). Nursing interventions to achieve haemostasis included use of manual pressure during all bleeding events, application of new or reinforced dressing (n=41, 78.8%), and the use of absorbable haemostat or other alternate wound dressing product (n=23, 44.2%). Nurses reported that their workload was adversely impacted during 31 bleeding events (59.6%), including delegation of tasks and/or patient care (n=16) and overtime work requirements (n=6). No patients required emergency surgical interventions; all were discharged alive. Conclusion The incidence of vascular access complications is infrequent, but management of bleeding events remains a clinical concern that impacts patients' experience and nursing workload. The transition of most PCI to radial access and the growing volume of structural heart procedures performed through femoral access highlight the need for cardiovascular nurses to develop and maintain competency in this evolving clinical context to help patients achieve safe haemostasis.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».