Effects of three methods of femoral site immobilization on bleeding and comfort after coronary angiogram

Abstract

BACKGROUND: Postangiogram femoral site care varies by institution and practitioner. The literature is unclear about which intervention provides the best hemostasis and patient comfort. OBJECTIVE: To investigate which method of femoral site immobilization results in less bleeding and more comfort after coronary angiography. METHODS: Three hundred inpatients and outpatients undergoing coronary angiography in a large, metropolitan, tertiary care facility were assigned randomly to three types of femoral site immobilization. A three-group experimental design was used in this intervention study. Patients were on bedrest and received one of the following interventions to the affected (site of puncture) leg for 6 hours: group 1 had a sandbag applied to the femoral site, group 2 had a sheet over the affected leg and tucked under the mattress, and group 3 had verbal instruction to keep the leg straight and still. An ordinal level hemostasis scale was developed, with descriptors based on the extent of intervention necessary, ranging from 1 = none to 5 = surgical. A 17-item, Likert-type scale was used. RESULTS: The verbal instruction group experienced significantly more bleeding than the sandbag group. There was no difference in bleeding or comfort between the sandbag and sheet-tuck groups. CONCLUSIONS: Our results indicated that sheet-tuck immobilization of the affected leg provides the same degree of hemostasis to the femoral site after coronary angiography as the sandbag.

Evaluation of comfort level in patients with immobilization

“…The values of Cronbach's alpha (α) ranged from 0.74 -0.82. The structural validity of the questionnaire, which was tested with exploratory factor analysis, confirmed the single factor structure of the questionnaire [9,10].…”

“…However, in the available literature there are not many studies which have examined the level of comfort related to the immobilization used. Most of the studies evaluated the level of pain in the postoperative recovery using visual analogue (VAS) and verbal rating scale (VRS) or by assessing comfort theory and validity [9,10,12]. Thus, Howlin et al [12] assessed the level of comfort of head restraints and thermoplastic masks during radiotherapy only by VAS scale.…”

Turkish Version of Kolcaba's Immobilization Comfort Questionnaire: A Validity and Reliability Study

“…However, there is no standardized tool for assessing the degree of discomfort they feel during hospitalization. This methodological study was designed to apply the ICQ, which has been found to be valid and reliable for assessing patients undergoing coronary angiography [37], to the orthopedics and traumatology clinics and test its validity and reliability with a new population. Given that ICQ is not a commonly used tool, the literature review did not reveal any studies with which to cross-check our study results.…”

“…The validity and reliability study of the ICQ was conducted by Hogan-Miller, Rustad, Sendelbach, and Goldenberg [37], with contribution from Kolcaba, and included patients undergoing coronary angiography who were immobilized. Cronbach a was .74 for the first assessment and .67 for the second assessment [37]. No other studies using the ICQ were found during the literature search.…”

“…The first and second assessments were conducted by the same researcher to maintain reliability between assessments. The second assessment was not for retest analysis but to monitor the change in patients' comfort and pain, as described in Hogan-Miller et al's study and in Kolcaba's book [6,37].…”