Cardiac Catheterization

Risk Predictors CC and PCI

Predictors of Vascular
Complications Post
Diagnostic Cardiac
Catheterization and
Percutaneous Coronary
Interventions
Cheryl J. P. Dumont, PhD(c), RN, CCRN; Arlene W. Keeling, PhD, RN;
Cheryl Bourguignon, PhD, RN; Ian J. Sarembock, MB, ChB, MD;
Melanie Turner, RN, BSN

Care of patients after cardiac catheterization and/or percutaneous coronary intervention is largely the responsibility of nurses. The identification of risk factors for vascular complications from these procedures is important for the development of protocols to prevent complications. This article describes a retrospective, descriptive, and correlational study of 11,119 patients who underwent cardiac catheterization and/or percutaneous intervention,
Nurses need to develop safe protocols of care for patients post cardiac catheterization and percutaneous coronary intervention that are research and evidence based.

post femoral artery sheath removal may be safe for some patients.13,19,22,23 One report on the use of an arterial closure device stated that the vascular complication rate was only 0.78%, the time to hemostasis was 1.3 minutes, and the time to ambulation was within 5.5 minutes.24
Although this may have been true for a selected group of patients, there is a population of patients who require much longer initial compression time, longer time in bed, and careful selection of the method of vascular closure.
Research is needed to clearly define which patients can safely be ambulated and discharged quickly versus which patients require more conservative protocols of care. As healthcare evolves, new devices and drugs are continuously introduced, bringing with them new risks. The identification of high-risk patients will be important when trials for new products are implemented. Risk analysis may provide support for reimbursement for longer stays in a recovery area for high-risk patients.

CASE REPORT
LITERATURE
included because conflicting evidence of the role it plays in complications has been cited in other research.8,14
The presence of a venous sheath was included because it has been anecdotally suspected by clinical experts as a risk predictor.
In block 1 of the logistic regression model, the demographic variables of age greater than 70 years
(odds ratio [OR] = 2.4, P G .01), female gender (OR =
1.6, P G .01), and higher BMI (OR = 5.8, P G .05) were found to be significant predictors of complications. In block 2, with the addition of the comorbidities, age and sex remained significant. The only comorbidity found significant was RF (OR = 1.8, P 9 .01). In the final block of the regression, age, sex, and RF continued to be significant, and PCI (OR = 1.8, P 9 .01) and venous sheath (OR = 1.4, P G .05) added significance to the model. The R2 for the total logistic regression model was 0.04.
Only 32% of the sample were older than 70 years, but they represented 49% of those with complications.
Women made up only 37% of the sample but represented 50% of the patients with complications. Patients with RF represented 9% of the sample but 15% of those with complications. The variables BMI, HTN, DM,