The clinical effectiveness of length of bed rest for patients recovering from trans-femoral diagnostic cardiac catheterisation

Abstract

Background Cardiac catheterisation plays a vital role in the diagnosis and evaluation of cardiac conditions. The goal of management of patients after cardiac catheterisation is to reduce the risk of development of any local or prolonged vascular complications, in particular bleeding and haematoma formation at the puncture site. Bed rest and immobilisation of the affected leg are recommended practices to ensure adequate haemostasis at the femoral arterial puncture site and prevent complications. Objectives The objective of this review was to present the best available evidence for the optimal length of bed rest after trans-femoral diagnostic cardiac catheterisation. The main outcome of interest was the incidence of bleeding and haematoma formation following varying periods of bed rest. Search strategy We searched the following databases: CINAHL, Medline, Cochrane Library, Current Contents, EBSCO, Web of Science, Embase, British Nursing Index, Controlled clinical trials database, Google Scholar. Reference lists of relevant articles and conference proceedings were searched. We also contacted key organisations and researchers in the field. Selection criteria All randomised and quasi-randomised controlled trials that compared the effects of different lengths of bed rest following trans-femoral diagnostic cardiac catheterisation on patient outcomes were considered for inclusion in the review. Data collection and analysis Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials were assessed independently by two reviewers. Odds ratios (OR) for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, trials were considered separately. Main results Eighteen trials involving a total of 4294 participants were included in the review. One trial included three treatment groups. In seven trials among 747 people there was no significant difference in the incidence of bleeding following six or less than 6 h of bed rest (OR 1.47; 95% CI 0.60, 3.64). Likewise, there was no significant difference in the incidence of bleeding following bed rest at other time periods. In eight trials involving 2272 patients there was no significant difference in the incidence of haematoma formation following 6 or less than 6 h of bed rest (OR 0.82; 95% CI 0.59, 1.16). Significantly fewer patients randomised to less than 6 h of bed rest complained of back pain. The odds of developing back pain at 4 (OR 24.60; 95% CI 1.29, 469) and 24 h (OR 2.47; 95% CI 1.16, 5.23) following coronary catheterisation was significantly higher among patients randomised to 6 compared with 3 h of bed rest. Authors' conclusions There is evidence of no benefit relating to bleeding and haematoma formation in patients who have more than 3 h of bed rest following trans-femoral diagnostic cardiac catheterisation. However, there is evidence of benefit relating to decreased incidence and severity of back pain a...

Effect of early ambulation after transfemoral cardiac catheterization in Hong Kong: A single-blinded randomized controlled trial

“…Femoral artery is commonly used in daily cardiologic practice because of its larger diameter (3)(4)(5). However, the invasive transfemoral puncture approach can simultaneously incurs the risk of vascular complications, such as bleeding, hematoma at the puncture site, distal embolization and arterial thrombosis (6,7). To reduce complications, manual or mechanical application of firm pressure above the puncture site is needed.…”

“…Although vascular complications should be prevented, prolonged bed rest has been identified as the most difficult component of post cardiac catheterization care (11). The most frequent complaints from patients during prolonged bed rest are back pain and urinary discomfort including difficulty of using a bedpan or urinal in the recumbent position and urinary retention (2,3,7,12). Besides, anxiety and anger due to the unmet needs for comfort are also expressed by patients (13,14).…”

“…The duration of the bed rest varies from 2 to 24 hours and there is no recommendation on the optimal duration of such a bed rest (7,10). Although vascular complications should be prevented, prolonged bed rest has been identified as the most difficult component of post cardiac catheterization care (11).…”

“…To reduce complications, manual or mechanical application of firm pressure above the puncture site is needed. Moreover, prolonged bed rest in recumbent position and immobilization of the affected leg are also required for those patients after sheath removal (7,8).…”

Bed rest for preventing complications after transfemoral cardiac catheterisation: a protocol of systematic review and network meta-analysis

“…To reduce complications, manual or mechanical application of a firm pressure above the puncture site is needed [ 9 ]. Bed rest in recumbent position and immobilisation of the affected leg are also required for such patients after sheath removal [ 10 , 11 ]. Restricted bed rest and leg immobilisation have been considered essential to reduce the risk of developing complications [ 2 ].…”