1 TLB PowerPoint presented By Takaya L Brown BSN BSN CMSRN What is PCI Percutaneous Coronary Intervention a nonsurgical procedure that is done to open narrowed coronary arteries performed by introducing a catheter through the skin into an artery groin or arm ID: 376486
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Slide1
Managing risk of complications at femoral vascular access sites in PCI
1
TLB
PowerPoint presented
By
Takaya L. Brown, BSN, BSN, CMSRNSlide2
What is PCI?
Percutaneous Coronary Intervention :
a nonsurgical procedure that is done to open narrowed coronary arteries; performed by introducing a catheter through the skin into an artery (groin or arm).
This procedure is performed when a patient has an acute coronary syndrome or a non-ST elevation MI.
PCI reduces morbidity and mortality from cardiovascular disease.
http://www.emedicinehealth.com/percutaneous_coronary_intervention_pci/article_em.htm
2
TLBSlide3
Femoral Vascular access complications
Because PCI requires the use of potent antithrombotic agents/
Antithrombin medications, there is an increased risk of:
Hematoma
Retroperitoneal hematoma
PseudoaneurysmArterial occlusionArteriovenous fistulaIncreased morbidity/mortalityIncreased costs
FVACs reported during PCI are 5.5-20%.
Merriweather, N. & Sulzbach-Hoke, L. (2012).
Managing risk of complications at femoral vascular
access sites in PCI.
Critical care nurse, 32(5): 16-29.
3
TLBSlide4
Risks factors for FVACs
ModifiableProcedural technique
MedicationsHemostasis method
Non-modifiable
Sex
AgeBMIBlood pressureMerriweather
, N. & Sulzbach-Hoke, L. (2012). Managing risk of complications at femoral vascular access sites in PCI.
Critical care nurse, 32(5): 16-29.
Since nurses are generally the ones to pull the catheters or sheaths, it is important to understand causes and predisposing risk factors of VASCs.
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TLBSlide5
Femoral access
Many VASCs are related to punctures being made
either too high or too low below the inguinal
ligament.
Low sticks can lead to
pseudoaneurysm, hematoma, or AV fistula.Merriweather, N. & Sulzbach-Hoke, L. (2012).
Managing risk of complications at femoral vascular access sites in PCI. Critical care nurse, 32(5): 16-29.
5
TLBSlide6
Table 1 Femoral puncture location and associated
complicationsaFemoral puncture location: definition
Low stick: puncture below the femoral bifurcation
High stick: puncturing the inferior
epigastric
arteryPosterior wall puncture: puncture through the backwall of the arteryComplicationsPseudoaneurysmHematomaArteriovenous fistulaRetroperitoneal hemorrhage
Retroperitoneal hemorrhagea Based on data from Turi,7 Ragosta,8 Baim
and Simon,15 Kamineni and Butman,18 and Rashid and Bailey
Merriweather
, N. &
Sulzbach-Hoke, L. (2012). Managing risk of complications at femoral vascular
access sites in PCI. Critical care nurse, 32(5)
: 16-29.
6
TLBSlide7
medications
Combinations of oral, IV antiplatelet
, and antithrombin therapy are used for patients with ACS (USA and non-STEMI).
They reduce mortality rates
They reduce adverse ischemic events, such as recurrent MI
They reduce short and long term complications of PCIAntithrombinAntiplatelets
Inhibits the coagulation factors that act in the clotting cascade to form fibrin strandsUnfractionated
heparin (UFH)Low molecular weight heparin (LMWH): little effect on measurements of activated clotting time
Direct thrombin inhibitors (
bivalrudin
, argatroban
): interact directly with thrombin without the need for cofactorPrevent formation of clots by allowing platelets to be activated
Glycoprotein
Iib
/
IIIa
(
reopro
,
integrilin
,
aggrastat
)
Adenosine
diphosphate
inhibitors
(
plavix
,
prasugrel
)
aspirin
Merriweather
, N. &
Sulzbach-Hoke, L. (2012). Managing risk of complications at femoral vascular access sites in PCI. Critical care nurse, 32(5): 16-29.
7
TLBSlide8
TLB
8
These organizations support early administration of glycoprotein
IIB/
IIIa
inhibitors for patients at high risk for thrombotic
events related to bleeding.
Merriweather
, N. &
Sulzbach-Hoke, L. (2012). Managing risk of complications at femoral vascular
access sites in PCI. Critical care nurse, 32(5): 16-29.Slide9
Hemostasis methods
There are three main techniques for obtaining hemostasis
:Manual compression
Mechanical compression
Vascular closure devices
Merriweather, N. & Sulzbach-Hoke, L. (2012). Managing risk of complications at femoral vascular
access sites in PCI. Critical care nurse, 32(5): 16-29.
9
TLBSlide10
Manual pressure
This is the gold standard for pulling sheaths and obtaining
hemostasis.Place index and middle fingers 1-2cm above puncture site and apply
pressure for 15-20 minutes.
This can lead to VASCs due to varying amounts of pressure being applied
as a result of hand and arm fatigue.
10TLB
Merriweather
, N. &
Sulzbach-Hoke
, L. (2012). Managing risk of complications at femoral vascular access sites in PCI. Critical care nurse,
32(5): 16-29.Slide11
Mechanical pressure
TLB
11
Applying constant pressure on the artery by use of:
C-clamp
Pneumatic device(Fem-stop)
Merriweather
, N. &
Sulzbach-Hoke
, L. (2012).
Managing risk of complications at femoral vascular
access sites in PCI.
Critical care nurse,
32(5)
: 16-29.Slide12
Vascular closure
TLB
12
This method was first approved in the 1990’s as a means for reducing length
of
bedrest, improving hemostasis, and for patient’s comfort. Methods used: -sutures for tying of the femoral artery -collagenlike plugs which seals the puncture site by stimulating
platelet aggregation -staples/clips which seal off puncture site in the artery
starclose
angioseal
perclose
Merriweather
, N. &
Sulzbach-Hoke
, L. (2012).
Managing risk of complications at femoral vascular
access sites in PCI.
Critical care nurse,
32(5)
: 16-29.Slide13
Nursing implications
Critically ill patients are at high risk for VASCs because of comorbid
conditions, such as, -renal failure -hypertension
-advanced age
The goal for nursing is to maintain
hemostasis at the puncture site. This goal will be attained by frequent assessment of VASCs: -frequent vital sign checks -frequent puncture site checks for bleeding or hematoma -frequent pulse checks of affected limbTLB
13
Merriweather, N. &
Sulzbach-Hoke
, L. (2012).
Managing risk of complications at femoral vascular access sites in PCI. Critical care nurse,
32(5): 16-29.Slide14
references
TLB
14
http://www.emedicinehealth.com/percutaneous_coronary_intervention_pci/article_em.htm
Merriweather
, N. & Sulzbach-Hoke, L. (2012). Managing risk of complications at femoral vascular access sites in PCI. Critical care nurse,
32(5): 16-29.Slide15
Article
TLB
15
Article can be found on the AACN (C1253) website. After completing the test, you will receive 1.0 contact hours
.
http://www.aacn.org/wd/Cetests/media/C1253.pdf