Ambulation after sheath removal: a comparison of 6 and 8 hours of bedrest after sheath removal in patients following a PTCA procedure.

OBJECTIVE

To determine whether ambulation of patients at 6 hours after sheath removal, compared with the institution's standard of 8 hours, would produce a change in hematoma formation, bleeding tendencies at the sheath introducer site, and/or patients' perceptions of pain after percutaneous transluminal coronary angioplasty (PTCA).

DESIGN

A quasi-experimental research design was used. Each patient was randomly assigned to either the control group, which required 8 hours of bedrest after sheath removal, or the experimental group, which required 6 hours of bedrest after sheath removal.

SETTING

Intensive care unit of a 400-bed urban teaching hospital in western Canada.

SAMPLE

A convenience sample of 85 male and female patients admitted to the intensive care unit after an elective PTCA between June 1991 and November 1992.

METHOD

Each subject was randomly assigned to 6 or 8 hours of bedrest after sheath removal. A demographic data tool, the short form of the McGill Pain Questionnaire, a Hematoma Assessment Instrument, and a Bleeding Tendency Assessment Instrument were used to collect the data. These instruments were administered to the patients at various intervals after sheath removal.

DATA ANALYSIS

Results were analyzed to determine if the additional 2 hours of bedrest in the control group contributed to an increase in pain perception. Demographic information was analyzed by use of descriptive statistics. Parametric and nonparametric tests were also used to analyze the data.

RESULTS

Ambulation of patients at 6 hours after sheath removal produced no significant increase in hematoma formation at the puncture site when compared with patients who ambulated 8 hours after sheath removal (p = 0.0001). There was a higher probability of a hematoma developing the day after the PTCA procedure if the activated clotting time (ACT) was high (p = 0.0034). Only one subject in the experimental group developed delayed bleeding; therefore, statistical analysis was unable to be performed on this data. When controlling for age, gender, type of procedure, previous PTCA, history of back pain, analgesic during the procedure, analgesic after the procedure, and cardiologist, the experimental group had significantly lower pain scores than the control group at 8 hours after sheath removal (p = 0.0001).

CONCLUSION

This study supports our hypothesis that decreasing the amount of time patients are required to remain flat and supine is associated with no increase in hematoma and bleeding tendencies and is associated with a reduction in the perceptions of pain. The results appear to support ambulation of patients at 6 hours after sheath removal.