Deuling J Han, Vermeulen Robert P, van den Heuvel Ad Fm, Schurer Remco Aj, van der Harst Pim
Department of Cardiology, University Medical Centre Groningen, The Netherlands.
Eur J Cardiovasc Nurs. 2017 Apr;16(4):344-351. doi: 10.1177/1474515116672123. Epub 2016 Oct 4.
Radial access is the preferential access route in patients undergoing diagnostic coronary angiography. We hypothesised that we could reduce hospital stay and improve patient comfort by accelerated deflation of the radial compression device (Terumo radial band).
The aim of this study was to compare accelerated pressure reduction with a standard Terumo radial band protocol with regard to local bleeding complications and reported pain scores after cardiac catheterisation.
We performed a single centre prospective randomised trial to compare accelerated care to standard care for patients undergoing diagnostic catheterisation through radial access. Patients in the accelerated care group started deflation after 1 hour, with a 2 ml/10-minute interval. Patients in the standard care group started after 2 hours with additional steps of deflation at 3 and 4 hours.
Of the 173 analysed patients 86 received accelerated care and 87 patients standard care. A total of 19 patients had pulsatile bleeding, which occurred similarly in the two groups (standard care 11 vs. accelerated care 8, P=0.47). The time to Terumo radial band removal was on average 129 minutes shorter for accelerated care patients compared to standard care ( P<0.01). At 1 hour after Terumo radial band placement, accelerated care patients more often reported pain scores of 0 than standard care patients (89% vs. 74%, P=0.02).
There was no increase in local bleedings in the accelerated pressure reduction of the Terumo radial band after diagnostic cardiac catheterisation, increasing patient comfort and reducing hospital stay. These findings will further facilitate the widespread implementation of radial access.
桡动脉穿刺是接受诊断性冠状动脉造影患者的首选穿刺途径。我们推测，通过加速桡动脉压迫装置（泰尔茂桡动脉压迫带）放气，可以缩短住院时间并提高患者舒适度。
本研究旨在比较加速减压与标准泰尔茂桡动脉压迫带方案在心脏导管插入术后局部出血并发症及报告的疼痛评分方面的差异。
我们进行了一项单中心前瞻性随机试验，比较经桡动脉途径进行诊断性导管插入术患者的加速护理与标准护理。加速护理组患者在1小时后开始放气，放气间隔为每10分钟2毫升。标准护理组患者在2小时后开始放气，并在3小时和4小时增加额外的放气步骤。
在173例分析患者中，86例接受加速护理，87例接受标准护理。共有19例患者出现搏动性出血，两组发生率相似（标准护理组11例 vs. 加速护理组8例，P = 0.47）。与标准护理相比，加速护理患者移除泰尔茂桡动脉压迫带的时间平均缩短129分钟（P < 0.01）。在放置泰尔茂桡动脉压迫带1小时后，加速护理组患者报告疼痛评分为0的比例高于标准护理组（89% vs. 74%，P = 0.02）。
诊断性心脏导管插入术后，泰尔茂桡动脉压迫带加速减压不会增加局部出血，可提高患者舒适度并缩短住院时间。这些发现将进一步促进桡动脉穿刺的广泛应用。
