Cardiac Medical Unit, Grantham Hospital, Hong Kong.
Int J Nurs Stud. 2013 Oct;50(10):1304-13. doi: 10.1016/j.ijnurstu.2012.12.023. Epub 2013 Jan 23.
Transradial coronary angiography (CA) and percutaneous coronary intervention (PCI) are gaining worldwide popularity due to the low incidence of major vascular complications and early mobilization of patients post procedures. Although post transradial access site complications are generally considered as minor in nature, they are not being routinely recorded in clinical settings.
To evaluate the incidence of access site complications and level of puncture site pain experienced by patients undergoing transradial coronary procedures and to examine factors associated with access site complications occurrence and puncture site pain severity.
A cross-sectional correlational study of 85 Chinese speaking adult patients scheduled for elective transradial CA and or PCI. Ecchymosis, bleeding, hematoma and radial artery occlusion (RAO) were assessed through observation, palpation and plethysmographic signal of pulse oximetry after coronary procedures. Puncture site pain was assessed with a 100mm Visual Analogue Scale. Factors that were related to access site complications and puncture site pain were obtained from medical records.
Ecchymosis was the most commonly reported transradial access site complication in this study. Paired t-test showed that the level of puncture site pain at 24 h was significantly (p<0.001) lower than that at 3 h after the procedure. Stepwise multivariable regression showed that female gender and shorter sheath time were found to be significantly associated with bleeding during gradual deflation of compression device. Only longer sheath time was significantly associated with RAO. Female gender and larger volume of compression air were associated with the presence of ecchymosis and puncture site pain at 3 h after procedure, respectively.
The study findings suggest that common access site complications post transradial coronary procedures among Chinese population are relatively minor in nature. Individual puncture site pain assessment during the period of hemostasis is important. Nurses should pay more attention to factors such as female gender, sheath time and volume of compression that are more likely to be associated with transradial access site complications and puncture site pain.
经桡动脉冠状动脉造影（CA）和经皮冠状动脉介入治疗（PCI）由于术后主要血管并发症发生率低和患者早期活动，在全球范围内越来越受欢迎。尽管经桡动脉入路部位并发症通常被认为性质较轻，但在临床环境中并未常规记录。
评估接受经桡动脉冠状动脉介入治疗的患者的入路部位并发症发生率和穿刺部位疼痛程度，并探讨与入路部位并发症发生和穿刺部位疼痛严重程度相关的因素。
这是一项对 85 名接受择期经桡动脉 CA 和/或 PCI 的讲中文的成年患者进行的横断面相关性研究。通过冠状动脉介入术后观察、触诊和脉搏血氧仪的容积描记信号评估瘀斑、出血、血肿和桡动脉闭塞（RAO）。采用 100mm 视觉模拟量表评估穿刺部位疼痛。从病历中获取与入路部位并发症和穿刺部位疼痛相关的因素。
在本研究中，瘀斑是最常见的经桡动脉入路部位并发症。配对 t 检验显示，术后 24 小时的穿刺部位疼痛程度明显（p<0.001）低于术后 3 小时。逐步多元回归显示，女性性别和较短的鞘管时间与逐渐减压压迫装置时出血显著相关。只有较长的鞘管时间与 RAO 显著相关。女性性别和较大的压迫空气量与术后 3 小时出现瘀斑和穿刺部位疼痛有关。
研究结果表明，中国人群经桡动脉冠状动脉介入治疗后常见的入路部位并发症性质相对较轻。在止血期间评估个体穿刺部位疼痛很重要。护士应更加关注女性性别、鞘管时间和压迫空气量等因素，这些因素更可能与经桡动脉入路部位并发症和穿刺部位疼痛相关。
