Vascular access complications after interventional and structural procedures: Prospective observational cohort study to guide contemporary nursing practice
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".