Peet G I, McGrath M A, Brunt J H, Hilton J D
Can J Cardiovasc Nurs. 1995;6(3-4):13-9.
A cross-sectional survey was conducted to examine current Canadian practices in the nursing and medical management of femoral arterial sheath removal (SR) after PTCA (percutaneous transluminal coronary angioplasty). The purposes of the study were to (a) investigate the roles of the nurses and physicians in SR, (b) assess the length of time arterial sheaths are left in place and patients kept on bedrest, and (c) describe the routine medical protocols used for pain and anticoagulation therapy. Of the 35 hospitals that perform PTCA in Canada, 30 responded to the survey (response rate of 86%). Nurses had primary responsibility for SR in 13% of the sites and shared responsibility with physicians for SR in a further 10% of the institutions. When nurses were trained to remove sheaths, they assumed responsibility for the adjunctive steps to establish hemostasis. One third of hospitals removed sheaths in 4 hours or less; approximately 75% of them removed sheaths in 6 hours or less after PTCA. Patients are kept on bedrest for 6 hours or less following hemostasis in half, and 8 hours or less at three-quarters of the hospitals. Post-PTCA and pre-SR anticoagulant monitoring was used in almost half of the sites. Premedication for SR varied from no premedication to combinations of three intravenous medications plus local anaesthetic. Survey results showed that in almost one quarter of the Canadian institutions where PTCA is performed, nurses play a role in SR. Results also showed that there is no uniformity in post-PTCA SR across Canada and that further research is needed to identify the optimum approach to managing this common cardiovascular procedure.
开展了一项横断面调查，以研究加拿大目前在经皮腔内冠状动脉成形术（PTCA）后股动脉鞘移除（SR）的护理和医疗管理方面的做法。该研究的目的是：（a）调查护士和医生在SR中的作用；（b）评估动脉鞘留置的时间长度以及患者卧床休息的时间；（c）描述用于疼痛和抗凝治疗的常规医疗方案。在加拿大进行PTCA的35家医院中，有30家回应了调查（回应率为86%）。在13%的机构中，护士对SR负主要责任，在另外10%的机构中，护士与医生共同负责SR。当护士接受鞘移除培训后，他们承担了建立止血的辅助步骤的责任。三分之一的医院在4小时或更短时间内移除鞘；其中约75%的医院在PTCA后6小时或更短时间内移除鞘。一半的医院在止血后让患者卧床休息6小时或更短时间，四分之三的医院让患者卧床休息8小时或更短时间。几乎一半的机构在PTCA后和SR前进行抗凝监测。SR的术前用药从不用药到三种静脉药物加局部麻醉剂的组合不等。调查结果显示，在加拿大几乎四分之一进行PTCA的机构中，护士在SR中发挥作用。结果还表明，加拿大各地PTCA后的SR没有统一标准，需要进一步研究以确定管理这一常见心血管手术的最佳方法。
