Care of the post percutaneous coronary intervention patient.

• Jurisdiction: Australia
• Author: Mills, Cally
• Date: 01 February 2012

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Introduction

The number of patients undergoing a percutaneous coronary intervention (PCI) has dramatically increased.

In Australia in 2008, 155 per 100,000 of population underwent PCI; compared with 61 per 100,000 undergoing coronary artery bypass surgery (AIHW 2010). Evidence regarding current care of the patient post PCI highlights nursing interventions such as: nursing supine; the time to ambulation following sheath removal; and use of arterial closure devices.

In Australia and New Zealand, a recent study demonstrates a wide variation in routine practice of cardiac nurses, and a lack of clinical guidelines to assist this process (Rolley et al 2010). This practice opinion article is aimed to discuss recent literature in regards to advances in nursing care for the patient post PCI and the implications this holds for current clinical practice and potentially future research.

Nursing interventions

A PCI involves the passing of a catheter through a sheath that is inserted into the femoral artery. The sheath is removed at the end of the procedure and pressure applied to the insertion site (Walker et al 2008). Three main nursing interventions involved in post PCI care are investigated: nursing patient's supine; the time to ambulation post sheath removal; and the use of vascular closure devices.

Supine nursing

Nursing care for patients who have undergone PCI involves prevention of potential complications such as haematoma and bleeding from the femoral artery, with supine nursing most often used in nursing practice, particularly so in Australia and NZ (Rolley et at 2010). Physical complications from supine nursing include haemodynamic instability due to the physiological responses to back pain as well as urinary retention (Rezaei et at 2009). A randomised control trial investigating positioning protocols post PCI found that patients who had modified positioning and pillow support had much less back pain with no accompanying increase in complications as compared with those who were nursed supine (Rezaei et al 2009). From the patient's perspective, lying supine for long periods of time can have negative impacts such as being dependant on the nurse for bodily function needs, pain and the discomfort of not being able to move freely (Lunden et al 2006). Anxiety associated with physical immobility and pain is also of great importance to patient care, with patients often experiencing a high level of anxiety before the PCI...