Early mobilisation after coronary angiography to reduce back pain

BACKGROUND Coronary heart disease accounts for over 25,000 inpatient admissions and nearly 4,000 day-case admissions in New Zealand per year (Hay, 2004). Cardiac catheterization, via the femoral artery, is a common procedure undertaken to assess for and treat coronary heart disease (Chair, Li and Wong, 2004; Chandrasekar et al., 2001; Wang, Redeker, Moreyra & Diamond, 2001). After the procedure, the patient remains on bed rest (mainly supine with the affected leg straight) for at least a further 4-6 hours (Sabo, Chlan and Savik, 2008) in order to reduce the chances of complications at the groin site (Chair, Taylor-Piliae, Lam and Chan, 2003). Due to this enforced supine bed rest, immobilization and restricted positioning, patients frequently experience back pain (Chair et al., 2003). Prolonged bed rest causes pressure to be exerted continuously onto the same back muscles, causing muscle fatigue and weakness. This fatigue causes back pain due to back spasms (Chair et al., 2004). OBJECTIVES The aim of this thesis was to, via a Systematic Review and Meta-Analysis, ascertain whether it is safe for nurses to mobilise patients out of bed four hours or earlier after a femoral approach coronary angiogram without the use of a vascular closure device, in order to reduce back pain whilst not increasing the risk of vascular complications at the puncture site. METHODOLOGY The research question was answered by completing a Systematic Review and Meta-Analysis, which included fifteen studies; eleven randomised, two quasi-randomised and two non-randomised controlled trials. The studies were collated, evaluated and summarised using the Cochrane Collaboration’s framework. Each individual study was also graded for quality of the evidence by allocating a level to it using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Groups grades of evidence (Schunemann et al., 2008). SELECTION CRITERIA All randomised controlled trials (RCT’s), quasi-randomised controlled and non-randomised controlled trials found in the literature search, that compared the safety of early mobilisation with vascular complications after a femoral approach diagnostic coronary angiogram, were considered for inclusion in the review. In all, 15 studies from around the world, published since 1996, were chosen. DATA COLLECTION AND ANALYSIS Once studies had been obtained, they were vetted against the inclusion and exclusion criteria for this review. The article was thoroughly scrutinised and if it was suitable went for data collection. Three assessors decided inclusion or exclusion of each study. This reduced the chance of selection bias in the review. Risk ratios and 95% confidence intervals were calculated for all studies. A Meta-Analysis was then undertaken including all of the diagnostic coronary angiogram studies, with separate analysis of just the randomised controlled trials. MAIN RESULTS Six studies looked at mobilisation at ≤ 2 hours after a diagnostic angiogram. There was no significant difference overall in incidence of vascular complications in these studies (RR 1.1591; 95% CI 0.7544-1.7809; P 0.5023). Ten studies looked at the safety of mobilisation at ≤ 3 hours with no statistical significance in overall vascular complications (RR 0.8430; 95% CI 0.7041-1.0094; P 0.0625). All 15 studies mobilised their participants at ≤ 4 hours, again with no statistical significance in complications (RR 0.8696; 95% CI 0.7399-1.0219; P 0.0891). AUTHOR'S CONCLUSIONS The results from this study show no statistically significant difference in vascular complications between the control groups and the early mobilisation out of bed groups at ≤2, 3 or 4 hours post femoral approach coronary angiogram. Therefore, mobilisation after coronary angiogram may be as safe at 1 ½ to 4 hours mobilisation as it is at 6 hours and may have a positive benefit of reducing back pain related to lying in bed.

Name thesis:degree_name

Master of Nursing

Level thesis:degree_level

Masters

Grantor

Eastern Institute of Technology

Year dc:date.issued

2012

Author dc:creator

• Burn, Kelly

• coronary heart disease
• cardiac catheterisation
• angiography
• angiogram
• back pain
• mobilisation
• ambulation
• safety
• systematic review
• meta-analysis

Statement dc:rights

• All rights reserved

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/10652/6532

OAI identifier oai:identifier

oai:null:10652/6532