Early Ambulation After Transfemoral Catheterization Helen Condry, RN, BSN, MSN Candidate

University of Central Florida Email: hcondry@knights.ucf.edu

Abstract
Diagnostic cardiac catheterization is the gold standard procedure to diagnose coronary artery disease and valvular disease. Bed rest is ordered after femoral artery access to decrease the risk of complications but that time varies around the world. Studies analyzed included all randomized and non-randomized trials published from January, 2000 to June 2013 that compared adults recovering from a femoral access with bed rest times of more than four hours to three hours or less and examined complications. No significant differences were found with the incidence of hematomas in 10 out of 12 studies; no significant differences were found with the incidence of bleeding in nine trials. Practice recommendations are that bed rest may be safely reduced to three or less hours.

Methods
Analyzed all trials from 2000 through June 2013 that compared adults post-arterial femoral access with bed rest times of 4 or more hours to 3 hours or less. 12 trials were included: 1 meta-analysis, 6 RCT, and 5 non-RCT. 6,504 patients and a mean age of 57.6 years.

Studies with Bleeding Percentages

Discomfort Results

Conclusions
No significant differences were found with the incidence of bleeding in 8 out of 9 trials. No significant differences were found with the incidence of hematomas in 10 out of 12 studies. Patient discomfort was reduced with decreased immobilization.

Femoral Access for Catheterization

Background
Gold standard procedure to identify heart disease In U.S. alone, over 1 million cardiac catheterizations are done yearly (Roger et al., 2012)
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Practice Recommendations Studies with Hematoma Percentages

Bed rest may be safely reduced to 3 or less hours without a significant increase in vascular complications. Reducing bed rest to 3 hours or less will significantly decrease patient discomfort and will increase patient satisfaction. Reducing bed rest time can potentially save multiple nursing hours which leads to lower labor costs and higher profit margins.

One of the most common procedures worldwide (Cove, 2009) Bed rest ordered post sheath removal to decrease complications Bed rest varies around the world from 2 hours to 24 hours (Chair et al., 2008) Comfort affected, especially back pain with longer immobilization

Results from Meta-analysis

Bleeding: Mohammady et al. (2013) in 3 trial
subgroup showed no significant differences (OR 0.86; 95% CI [0.32, 2.33]).

Hematoma
Hematoma: Mohammady et al. (2013) in 3
trial subgroup showed more hematomas in control but not significant (OR 0.55; 95% CI [0.27, 1.14]).

U.S. nursing labor study showed average allinclusive cost for full-time hospital RN was $45/hour (KPMG Healthcare & Pharmaceutical Institute,
2011, p.8).

Discomfort: Mohammady et al. (2013) in 3 trial

subgroup showed significantly less pain from 2-4 hours bed rest compared to 6 hours (mean difference at 4 hours -0.60; 95% CI [-0.96, -0.24]).
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