The Efficacy of an Intervention Program for Pain Intensity Reduction in Patients Undergoing Arterial Sheath Removal after Coronary Artery Angioplasty
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Abstract
Background: Pain management after sheath removal is one of the most significant points in patient care. The use of a simple, practical, and combined method in this field is essential. The purpose of this study was to evaluate the efficacy of an intervention program for pain intensity reduction in patients undergoing arterial sheath removal after coronary artery angioplasty.
Methods: This semi-experimental study was conducted in 2020 on 90 eligible patients selected via the purpose-based method and randomly assigned to experimental and control groups. The intervention program for the experimental group included training to relax the abdominal muscles, deep and slow breathing, and precise pressure on the femoral pulse. Pain intensity was measured before, during, and several times after arterial sheath removal. The independent t, Fisher exact, and χ2 tests were used to analyze the data.
Results: Women comprised 66.6% of the study participants, who had a mean age of 58.20±8.70 years. No significant differences were observed concerning pain intensity, bleeding, pseudoaneurysm formation, and hematoma between the 2 groups before the intervention (P=0.531). However, during the intervention and in the fifth and tenth minutes after the intervention, pain intensity was lower in the experimental group (P<0.050), whereas no such differences were observed regarding bleeding, pseudoaneurysm formation, and hematoma.
Conclusions: Given the effectiveness of our intervention program in ameliorating pain intensity and vasovagal response after arterial sheath removal, we suggest that this program, along with prescription drugs, be used for the management of patients’ pain.
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2. Orellana JDY, Cunha GMD, Marrero L, Moreira RI, Leite IDC, Horta BL. Excesso de mortes durante a pandemia de COVID-19: subnotificação e desigualdades regionais no Brasil [Excess deaths during the COVID-19 pandemic: underreporting and regional inequalities in Brazil]. Cad Saude Publica 2021;37:e00259120.
3. Bakhshi F, Namjou Z, Andishmand A, Panabadi A, Bagherinasab M, Sarebanhassanabadi M. Effect of positioning on patient outcomes after coronary angiography: a single-blind randomized controlled trial. J Nurs Res 2014;22:45-50.
4. Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, Finkelstein EA, Hong Y, Johnston SC, Khera A, Lloyd-Jones DM, Nelson SA, Nichol G, Orenstein D, Wilson PW, Woo YJ; American Heart Association Advocacy Coordinating Committee; Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Arteriosclerosis; Thrombosis and Vascular Biology; Council on Cardiopulmonary; Critical Care; Perioperative and Resuscitation; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease; Council on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes Research. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 2011;123:933-944.
5. Moran A, Gu D, Zhao D, Coxson P, Wang YC, Chen CS, Liu J, Cheng J, Bibbins-Domingo K, Shen YM, He J, Goldman L. Future cardiovascular disease in china: markov model and risk factor scenario projections from the coronary heart disease policy model-china. Circ Cardiovasc Qual Outcomes 2010;3:243-252.
6. Hatmi ZN, Tahvildari S, Gafarzadeh Motlag A, Sabouri Kashani A. Prevalence of coronary artery disease risk factors in Iran: a population based survey. BMC Cardiovasc Disord 2007;7:32.
7. Sadeghi M, Haghdoost AA, Bahrampour A, Dehghani M. Modeling the burden of cardiovascular diseases in Iran from 2005 to 2025: the impact of demographic changes. Iran J Public Health 2017;46:506-516.
8. Michaud TC. Uneventful upper cervical manipulation in the presence of a damaged vertebral artery. J Manipulative Physiol Ther 2002;25:472-483.
9. Mikaeili-Mirak S, Talasaz AH, Jenab Y, Vatanara A, Amini M, Jalali A, Gheymati A. Novel combined topical gel of lidocaine-verapamil-nitroglycerin can dilate the radial artery and reduce radial pain during trans-radial angioplasty. Int J Cardiol Heart Vasc 2020;32:100689.
10. Darvishpour A, Javadi-Pashaki N, Salari A, Sadeghi T, Taleshan-Nejad M. Factors associated with quality of life in patients undergoing coronary angioplasty. Int J Health Sci (Qassim) 2017;11:35-41.
11. Naghipour B, Faridaalaee G, Shadvar K, Bilehjani E, Khabaz AH, Fakhari S. Effect of prophylaxis of magnesium sulfate for reduction of postcardiac surgery arrhythmia: randomized clinical trial. Ann Card Anaesth 2016;19:662-667.
12. Olson NC. Comparison of head elevation protocols following femoral artery sheath removal after coronary angiography. Crit Care Nurse 2016;36:20-34.
13. Bochenek T, Lelek M, Kowal-Kałamajka M, Kusz B, Szczogiel J, Jaklik A, Roleder T, Mizia-Stec K. Coronary interventions via radial artery without pre-procedural routine use of spasmolytic agents. Postepy Kardiol Interwencyjnej 2020;16:138-144.
14. Ali MIM, Albashir AAD, Elawad OAMA, Mohamed MAE. A case of successful coronary angioplasty in an achondroplasia patient with total occlusion of an anomalous right coronary artery (case report). BMC Cardiovasc Disord 2020;20:329.
15. Byrne RA, Stone GW, Ormiston J, Kastrati A. Coronary balloon angioplasty, stents, and scaffolds. Lancet 2017;390:781-792.
16. Nair M, Singal G, Yaduvanshi A, Kataria V. First in man: percutaneous coronary angioplasty using non-fluoroscopic electro-anatomic mapping. Int J Cardiovasc Imaging 2020;36:1189-1190.
17. Xu JP, Huang JY. Nitrates and risk of vasovagal reaction in femoral sheath removal after percutaneous intervention : A retrospective observational study. Herz 2021;46(Suppl 1):130-134.
18. Jin ZN, Chen YD, Lü SZ, Song XT, Zhu HG, Li H. Clinical and angiographic predictors of restenosis after bare metal stent deployment in coronary artery disease patients complicated with diabetes. Zhonghua Xin Xue Guan Bing Za Zhi 2006;34:1093-1096.
19. Aurora L, Ullah A, Kariyanna PT, Yurevich O, Chandrakumar HP, Cavusoglu E, Marmur JD, McFarlane IM. Vagal-induced complete heart block during coronary angiography due to bladder distention. Am J Med Case Rep 2020;8:56-59.
20. Tavakol M, Ashraf S, Brener SJ. Risks and complications of coronary angiography: a comprehensive review. Glob J Health Sci 2012;4:65-93.
21. Gach O, Davin L, Lempereur M, Marechal P, Martinez C, Lancellotti P. Angioplastie coronaire transluminale percutanée : de la révolution à l’évolution [Percutaneous transluminal coronary angioplasty: from revolution to evolution]. Rev Med Liege 2019;74(S1):S34-S38.
22. Isoda R, Morita I, Yoshida M. Iatrogenic femoral vein pseudoaneurysm. J Vasc Surg Cases Innov Tech 2020;6:285-287.
23. Hsieh LY, Chen YR, Lu MC. Efficacy of cold application on pain during chest tube removal: a randomized controlled trial: a CONSORT-compliant article. Medicine (Baltimore) 2017;96:e8642.
24. Su SF, Yeh WT. Music interventions in percutaneous coronary procedures: a meta-analysis. Clin Nurs Res 2021;30:135-145.
25. Aktaş YY, Karabulut N. The use of cold therapy, music therapy and lidocaine spray for reducing pain and anxiety following chest tube removal. Complement Ther Clin Pract 2019;34:179-184.
26. Niknam Sarabi H, Farsi Z, Butler S, Pishgooie AH. Comparison of the effectiveness of position change for patients with pain and vascular complications after transfemoral coronary angiography: a randomized clinical trial. BMC Cardiovasc Disord 2021;21:114.
27. Jafari H, Courtois I, Van den Bergh O, Vlaeyen JWS, Van Diest I. Pain and respiration: a systematic review. Pain 2017;158:995-1006.
28. Chalaye P, Goffaux P, Lafrenaye S, Marchand S. Respiratory effects on experimental heat pain and cardiac activity. Pain Med 2009;10:1334-1340.
29. Solloway MR, Taylor SL, Shekelle PG, Miake-Lye IM, Beroes JM, Shanman RM, Hempel S. An evidence map of the effect of Tai Chi on health outcomes. Syst Rev 2016;5:126.
30. Parach A, Sadeghi-Ghahroudi M, Saeid Y, Ebadi A. The effect of evidence-based care guidelines on outcomes after removal of arterial sheath in patients undergoing angioplasty. ARYA Atheroscler 2018;14:237-241.
31. Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, Harris JD. Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev 2018;2:e088.
32. Dowlatshahi D, Demchuk AM, Flaherty ML, Ali M, Lyden PL, Smith EE; VISTA Collaboration. Defining hematoma expansion in intracerebral hemorrhage: relationship with patient outcomes. Neurology 2011;76:1238-1244.
33. Panetta C, Rao S. Novel method for radial sheath removal using manual pressure over hemostatic pad combined with ulnar compression. Catheter Cardiovasc Interv 2018;92:322-324.
34. Lee MS, Kong J. Achieving safe femoral arterial access. Curr Cardiol Rep 2015;17:44.
35. Thong ISK, Jensen MP, Miró J, Tan G. The validity of pain intensity measures: what do the NRS, VAS, VRS, and FPS-R measure? Scand J Pain 2018;18:99-107.
36. Kiat Ang C, Leung DY, Lo S, French JK, Juergens CP. Effect of local anesthesia and intravenous sedation on pain perception and vasovagal reactions during femoral arterial sheath removal after percutaneous coronary intervention. Int J Cardiol 2007;116:321-326.
37. Mall A. Management of patients with femoral arterial sheaths following percutaneous coronary intervention. Crit Care Nurse 2019;39:75-77.
38. Su SF, Chang MY, Wu MS, Liao YC. Safety and efficacy of using vascular closure devices for hemostasis on sheath removal after a transfemoral artery percutaneous coronary intervention. Jpn J Nurs Sci 2019;16:172-183.
39. Rolantova L, Bulava A, Eisenberger M, Chloubova I, Tothova V, Hanis J. Nurse-performed venous sheath removal in patients undergoing radiofrequency catheter ablation for atrial fibrillation: a randomised study. Eur J Cardiovasc Nurs 2019;18:332-339.
40. Stegemann E, Busch L, Stegemann B, Lauer T, Hoffmann R, Heiss C, Kelm M. Evaluation of a structured training program for arterial femoral sheath removal after percutaneous arterial catheter procedures by assistant personnel. Am J Cardiol 2015;115:879-883.
41. Valikhani M, Mahdizadeh SM, Eshraghi A, Mazloum SR, Dehghani J. The Effect of simultaneous sand-ice bag application on hemorrhage and hematoma after percutaneous coronary intervention: a randomized clinical trial. J Caring Sci 2020;9:188-194.
42. Lu YZ, Chuang PY. Reducing the incidence of back pain in post-percutaneous coronary intervention patients with femoral sheath. Hu Li Za Zhi 2018;65:94-101.
43. Zucchelli G, Di Cori A, Segreti L, Laroche C, Blomstrom-Lundqvist C, Kutarski A, Regoli F, Butter C, Defaye P, Pasquié JL, Auricchio A, Maggioni AP, Bongiorni MG; ELECTRa Investigators. Major cardiac and vascular complications after transvenous lead extraction: acute outcome and predictive factors from the ESC-EHRA ELECTRa (European Lead Extraction ConTRolled) registry. Europace 2019;21:771-780.
2. Orellana JDY, Cunha GMD, Marrero L, Moreira RI, Leite IDC, Horta BL. Excesso de mortes durante a pandemia de COVID-19: subnotificação e desigualdades regionais no Brasil [Excess deaths during the COVID-19 pandemic: underreporting and regional inequalities in Brazil]. Cad Saude Publica 2021;37:e00259120.
3. Bakhshi F, Namjou Z, Andishmand A, Panabadi A, Bagherinasab M, Sarebanhassanabadi M. Effect of positioning on patient outcomes after coronary angiography: a single-blind randomized controlled trial. J Nurs Res 2014;22:45-50.
4. Heidenreich PA, Trogdon JG, Khavjou OA, Butler J, Dracup K, Ezekowitz MD, Finkelstein EA, Hong Y, Johnston SC, Khera A, Lloyd-Jones DM, Nelson SA, Nichol G, Orenstein D, Wilson PW, Woo YJ; American Heart Association Advocacy Coordinating Committee; Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Arteriosclerosis; Thrombosis and Vascular Biology; Council on Cardiopulmonary; Critical Care; Perioperative and Resuscitation; Council on Cardiovascular Nursing; Council on the Kidney in Cardiovascular Disease; Council on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes Research. Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 2011;123:933-944.
5. Moran A, Gu D, Zhao D, Coxson P, Wang YC, Chen CS, Liu J, Cheng J, Bibbins-Domingo K, Shen YM, He J, Goldman L. Future cardiovascular disease in china: markov model and risk factor scenario projections from the coronary heart disease policy model-china. Circ Cardiovasc Qual Outcomes 2010;3:243-252.
6. Hatmi ZN, Tahvildari S, Gafarzadeh Motlag A, Sabouri Kashani A. Prevalence of coronary artery disease risk factors in Iran: a population based survey. BMC Cardiovasc Disord 2007;7:32.
7. Sadeghi M, Haghdoost AA, Bahrampour A, Dehghani M. Modeling the burden of cardiovascular diseases in Iran from 2005 to 2025: the impact of demographic changes. Iran J Public Health 2017;46:506-516.
8. Michaud TC. Uneventful upper cervical manipulation in the presence of a damaged vertebral artery. J Manipulative Physiol Ther 2002;25:472-483.
9. Mikaeili-Mirak S, Talasaz AH, Jenab Y, Vatanara A, Amini M, Jalali A, Gheymati A. Novel combined topical gel of lidocaine-verapamil-nitroglycerin can dilate the radial artery and reduce radial pain during trans-radial angioplasty. Int J Cardiol Heart Vasc 2020;32:100689.
10. Darvishpour A, Javadi-Pashaki N, Salari A, Sadeghi T, Taleshan-Nejad M. Factors associated with quality of life in patients undergoing coronary angioplasty. Int J Health Sci (Qassim) 2017;11:35-41.
11. Naghipour B, Faridaalaee G, Shadvar K, Bilehjani E, Khabaz AH, Fakhari S. Effect of prophylaxis of magnesium sulfate for reduction of postcardiac surgery arrhythmia: randomized clinical trial. Ann Card Anaesth 2016;19:662-667.
12. Olson NC. Comparison of head elevation protocols following femoral artery sheath removal after coronary angiography. Crit Care Nurse 2016;36:20-34.
13. Bochenek T, Lelek M, Kowal-Kałamajka M, Kusz B, Szczogiel J, Jaklik A, Roleder T, Mizia-Stec K. Coronary interventions via radial artery without pre-procedural routine use of spasmolytic agents. Postepy Kardiol Interwencyjnej 2020;16:138-144.
14. Ali MIM, Albashir AAD, Elawad OAMA, Mohamed MAE. A case of successful coronary angioplasty in an achondroplasia patient with total occlusion of an anomalous right coronary artery (case report). BMC Cardiovasc Disord 2020;20:329.
15. Byrne RA, Stone GW, Ormiston J, Kastrati A. Coronary balloon angioplasty, stents, and scaffolds. Lancet 2017;390:781-792.
16. Nair M, Singal G, Yaduvanshi A, Kataria V. First in man: percutaneous coronary angioplasty using non-fluoroscopic electro-anatomic mapping. Int J Cardiovasc Imaging 2020;36:1189-1190.
17. Xu JP, Huang JY. Nitrates and risk of vasovagal reaction in femoral sheath removal after percutaneous intervention : A retrospective observational study. Herz 2021;46(Suppl 1):130-134.
18. Jin ZN, Chen YD, Lü SZ, Song XT, Zhu HG, Li H. Clinical and angiographic predictors of restenosis after bare metal stent deployment in coronary artery disease patients complicated with diabetes. Zhonghua Xin Xue Guan Bing Za Zhi 2006;34:1093-1096.
19. Aurora L, Ullah A, Kariyanna PT, Yurevich O, Chandrakumar HP, Cavusoglu E, Marmur JD, McFarlane IM. Vagal-induced complete heart block during coronary angiography due to bladder distention. Am J Med Case Rep 2020;8:56-59.
20. Tavakol M, Ashraf S, Brener SJ. Risks and complications of coronary angiography: a comprehensive review. Glob J Health Sci 2012;4:65-93.
21. Gach O, Davin L, Lempereur M, Marechal P, Martinez C, Lancellotti P. Angioplastie coronaire transluminale percutanée : de la révolution à l’évolution [Percutaneous transluminal coronary angioplasty: from revolution to evolution]. Rev Med Liege 2019;74(S1):S34-S38.
22. Isoda R, Morita I, Yoshida M. Iatrogenic femoral vein pseudoaneurysm. J Vasc Surg Cases Innov Tech 2020;6:285-287.
23. Hsieh LY, Chen YR, Lu MC. Efficacy of cold application on pain during chest tube removal: a randomized controlled trial: a CONSORT-compliant article. Medicine (Baltimore) 2017;96:e8642.
24. Su SF, Yeh WT. Music interventions in percutaneous coronary procedures: a meta-analysis. Clin Nurs Res 2021;30:135-145.
25. Aktaş YY, Karabulut N. The use of cold therapy, music therapy and lidocaine spray for reducing pain and anxiety following chest tube removal. Complement Ther Clin Pract 2019;34:179-184.
26. Niknam Sarabi H, Farsi Z, Butler S, Pishgooie AH. Comparison of the effectiveness of position change for patients with pain and vascular complications after transfemoral coronary angiography: a randomized clinical trial. BMC Cardiovasc Disord 2021;21:114.
27. Jafari H, Courtois I, Van den Bergh O, Vlaeyen JWS, Van Diest I. Pain and respiration: a systematic review. Pain 2017;158:995-1006.
28. Chalaye P, Goffaux P, Lafrenaye S, Marchand S. Respiratory effects on experimental heat pain and cardiac activity. Pain Med 2009;10:1334-1340.
29. Solloway MR, Taylor SL, Shekelle PG, Miake-Lye IM, Beroes JM, Shanman RM, Hempel S. An evidence map of the effect of Tai Chi on health outcomes. Syst Rev 2016;5:126.
30. Parach A, Sadeghi-Ghahroudi M, Saeid Y, Ebadi A. The effect of evidence-based care guidelines on outcomes after removal of arterial sheath in patients undergoing angioplasty. ARYA Atheroscler 2018;14:237-241.
31. Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, Harris JD. Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev 2018;2:e088.
32. Dowlatshahi D, Demchuk AM, Flaherty ML, Ali M, Lyden PL, Smith EE; VISTA Collaboration. Defining hematoma expansion in intracerebral hemorrhage: relationship with patient outcomes. Neurology 2011;76:1238-1244.
33. Panetta C, Rao S. Novel method for radial sheath removal using manual pressure over hemostatic pad combined with ulnar compression. Catheter Cardiovasc Interv 2018;92:322-324.
34. Lee MS, Kong J. Achieving safe femoral arterial access. Curr Cardiol Rep 2015;17:44.
35. Thong ISK, Jensen MP, Miró J, Tan G. The validity of pain intensity measures: what do the NRS, VAS, VRS, and FPS-R measure? Scand J Pain 2018;18:99-107.
36. Kiat Ang C, Leung DY, Lo S, French JK, Juergens CP. Effect of local anesthesia and intravenous sedation on pain perception and vasovagal reactions during femoral arterial sheath removal after percutaneous coronary intervention. Int J Cardiol 2007;116:321-326.
37. Mall A. Management of patients with femoral arterial sheaths following percutaneous coronary intervention. Crit Care Nurse 2019;39:75-77.
38. Su SF, Chang MY, Wu MS, Liao YC. Safety and efficacy of using vascular closure devices for hemostasis on sheath removal after a transfemoral artery percutaneous coronary intervention. Jpn J Nurs Sci 2019;16:172-183.
39. Rolantova L, Bulava A, Eisenberger M, Chloubova I, Tothova V, Hanis J. Nurse-performed venous sheath removal in patients undergoing radiofrequency catheter ablation for atrial fibrillation: a randomised study. Eur J Cardiovasc Nurs 2019;18:332-339.
40. Stegemann E, Busch L, Stegemann B, Lauer T, Hoffmann R, Heiss C, Kelm M. Evaluation of a structured training program for arterial femoral sheath removal after percutaneous arterial catheter procedures by assistant personnel. Am J Cardiol 2015;115:879-883.
41. Valikhani M, Mahdizadeh SM, Eshraghi A, Mazloum SR, Dehghani J. The Effect of simultaneous sand-ice bag application on hemorrhage and hematoma after percutaneous coronary intervention: a randomized clinical trial. J Caring Sci 2020;9:188-194.
42. Lu YZ, Chuang PY. Reducing the incidence of back pain in post-percutaneous coronary intervention patients with femoral sheath. Hu Li Za Zhi 2018;65:94-101.
43. Zucchelli G, Di Cori A, Segreti L, Laroche C, Blomstrom-Lundqvist C, Kutarski A, Regoli F, Butter C, Defaye P, Pasquié JL, Auricchio A, Maggioni AP, Bongiorni MG; ELECTRa Investigators. Major cardiac and vascular complications after transvenous lead extraction: acute outcome and predictive factors from the ESC-EHRA ELECTRa (European Lead Extraction ConTRolled) registry. Europace 2019;21:771-780.
| Files | ||
| Issue | Vol 16 No 3 (2021): J Teh Univ Heart Ctr | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v16i3.8186 | |
| Keywords | ||
| Angiography Pain Patients Nurses | ||
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How to Cite
1.
Heidaranlu E, Sedghi Goyaghaj N, Moradi A, Ebadi A. The Efficacy of an Intervention Program for Pain Intensity Reduction in Patients Undergoing Arterial Sheath Removal after Coronary Artery Angioplasty. J Tehran Heart Cent. 2021;16(3):102-108.
