Effect of Positioning on Patient Outcomes After Coronary Angiography

Abstract

Restoring patient homeostasis after coronary angiography, the gold standard diagnostic test for coronary heart disease is usually achieved by manual compression of the puncture site using a sandbag and prolonged bed rest. However, this process frequently results in patient complaints of back pain and discomfort. The aim of study was to assess the effect of positioning on patient outcomes after coronary angiography. This study used a single-blind randomized control trial approach. The sample consisted of 80 patients who had undergone a nonemergency coronary angiography via the femoral artery. Balanced block randomization was used to allocate participants into intervention and control groups. Routine care for the intervention group (n = 40) was adjusted to include the following: (1) intermittent changes to patient body and head position in bed during first 6 hours after catheterization, (2) reduction of sandbag compression time on the puncture site to 1 hour, and (3) regular examination for bleeding during the first 6 hours after catheterization. Intervention group participants were allowed to ambulate without restriction 6 hours after catheterization. Patients in the control group (n = 40) received routine care, consisting of (1) 6-24 hours of bed rest in the supine position with the affected leg fixed straight and immobilized and (2) sandbag compression on the puncture site for 6 hours. The main outcomes used in this study were level of back pain, discomfort, foot pain, bleeding, and hematoma. Intervention group patients had significantly less back pain and foot pain and higher comfort than the control group at the second, third, and sixth hour after catheterization (p = .00). There was no significant difference between the two groups in terms of amount of bleeding and hematoma (p > .05). Findings suggest that changes in patient position may be safer in the early period of postcatheterization bed rest than currently indicated in standard practice protocols. Furthermore, limiting sandbag compression to 1 hour has no measurable effect on the incidence and severity of vascular complications.