Biomedical subjects

B Fowlow

Publications and source records attributed to B Fowlow.

3 recordsLinked to original sources

PubMed1994

Research-based practice: early ambulation for PTCA patients.

Nursing practice based on clinical research is essential for defending nursing as a profession and for ensuring high quality, cost-effective, and innovative care. A recent study involving the care of patients experiencing a coronary angioplasty has had an impact on the nursing practice in a large tertiary care institution. A convenience sample of 85 patients admitted for a percutaneous transluminal coronary angioplasty (PTCA) were randomly assigned to either the control group, who remained on 8 hours of bedrest post sheath removal, or the experimental group who remained on only 6 hours of bedrest post sheath removal. At 2 hour intervals data were collected regarding pain, bleeding, and hematoma formation. Patients who ambulated at 6 hours experienced significantly less discomfort and no increase in bleeding or hematoma formation. In this institution patients are now able to ambulate 6 hours after the sheaths have been removed post PTCA.

Angioplasty, Balloon, Coronary↗

PubMedDate not supplied

Ambulation after sheath removal: a comparison of 6 and 8 hours of bedrest after sheath removal in patients following a PTCA procedure.

OBJECTIVE: To determine whether ambulation of patients at 6 hours after sheath removal, compared with the institution's standard of 8 hours, would produce a change in hematoma formation, bleeding tendencies at the sheath introducer site, and/or patients' perceptions of pain after percutaneous transluminal coronary angioplasty (PTCA). DESIGN: A quasi-experimental research design was used. Each patient was randomly assigned to either the control group, which required 8 hours of bedrest after sheath removal, or the experimental group, which required 6 hours of bedrest after sheath removal. SETTING: Intensive care unit of a 400-bed urban teaching hospital in western Canada. SAMPLE: A convenience sample of 85 male and female patients admitted to the intensive care unit after an elective PTCA between June 1991 and November 1992. METHOD: Each subject was randomly assigned to 6 or 8 hours of bedrest after sheath removal. A demographic data tool, the short form of the McGill Pain Questionnaire, a Hematoma Assessment Instrument, and a Bleeding Tendency Assessment Instrument were used to collect the data. These instruments were administered to the patients at various intervals after sheath removal. DATA ANALYSIS: Results were analyzed to determine if the additional 2 hours of bedrest in the control group contributed to an increase in pain perception. Demographic information was analyzed by use of descriptive statistics. Parametric and nonparametric tests were also used to analyze the data. RESULTS: Ambulation of patients at 6 hours after sheath removal produced no significant increase in hematoma formation at the puncture site when compared with patients who ambulated 8 hours after sheath removal (p = 0.0001). There was a higher probability of a hematoma developing the day after the PTCA procedure if the activated clotting time (ACT) was high (p = 0.0034). Only one subject in the experimental group developed delayed bleeding; therefore, statistical analysis was unable to be performed on this data. When controlling for age, gender, type of procedure, previous PTCA, history of back pain, analgesic during the procedure, analgesic after the procedure, and cardiologist, the experimental group had significantly lower pain scores than the control group at 8 hours after sheath removal (p = 0.0001). CONCLUSION: This study supports our hypothesis that decreasing the amount of time patients are required to remain flat and supine is associated with no increase in hematoma and bleeding tendencies and is associated with a reduction in the perceptions of pain. The results appear to support ambulation of patients at 6 hours after sheath removal.

Adult↗

PubMedDate not supplied

Thermodilution cardiac output determinations: a comparison of iced and refrigerated injectate temperatures in patients after cardiac surgery.

OBJECTIVE: To compare cardiac output determinations with two temperatures of injectate: iced (0 degrees to 6 degrees C) and refrigerated (10 degrees to 16 degrees C) in adult patients after cardiac surgery. DESIGN: A quasi-experimental study design was used. The dependent variable was cardiac output. The independent variable was injectate temperature. Each patient served as his or her own control. SETTING: Intensive care unit at a 500-bed urban teaching hospital in Western Canada. SAMPLE: A convenience sample of 40 male and female patients admitted to the intensive care unit after myocardial revascularization and/or valvular surgery between March and August 1991. All patients experienced surgery with the normothermic technique. METHOD: Each subject had cardiac output determinations performed within 12 hours of surgery with both 10 ml refrigerated and 10 ml iced injectate. The capped syringe technique was used. DATA ANALYSIS: A paired t test was performed to determine statistically significant differences between the two sets of measurements. Regression analysis was used to determine strength of agreement between the two techniques. Clinical significance was examined by a difference in mean cardiac output greater than 15% resulting in an alteration in medical therapy. RESULTS: There were no statistically or clinically significant differences between the two methods of cardiac output determinations. Regression analysis showed very good agreement (r = 0.965, p < 0.0001). Clinically, when the two cardiac outputs were reported to the surgeon, medical therapy was not altered based on differences. CONCLUSIONS: The use of 10 ml of refrigerated injectate provides reproducible cardiac output results as compared with iced injectate in normothermic patients after cardiac surgery. Further investigation is required to generalize these results to other patient populations and to determine the reproducibility with a lower volume of injectate.

Adult↗