The clinical effectiveness of length of bed rest for patients recovering from trans-femoral diagnostic cardiac catheterisation

Chair, Sek Ying, Fernandez, Ritin N., Lui, May How-Lin, Lopez, Violeta and Thompson, David R. (2008) The clinical effectiveness of length of bed rest for patients recovering from trans-femoral diagnostic cardiac catheterisation. International Journal of Evidence-Based Healthcare, 6 4: 352-390. doi:10.1111/j.1744-1609.2008.00111.x


Author Chair, Sek Ying
Fernandez, Ritin N.
Lui, May How-Lin
Lopez, Violeta
Thompson, David R.
Title The clinical effectiveness of length of bed rest for patients recovering from trans-femoral diagnostic cardiac catheterisation
Journal name International Journal of Evidence-Based Healthcare   Check publisher's open access policy
ISSN 1744-1595
1744-1609
Publication date 2008-11-05
Year available 2008
Sub-type Article (original research)
DOI 10.1111/j.1744-1609.2008.00111.x
Open Access Status
Volume 6
Issue 4
Start page 352
End page 390
Total pages 39
Place of publication Carlton South, Vic.
Publisher Blackwell Publishing for the Joanna Briggs Institute
Language eng
Subject C1
920103 Cardiovascular System and Diseases
920408 Health Status (e.g. Indicators of Well-Being)
110201 Cardiology (incl. Cardiovascular Diseases)
110310 Intensive Care
Formatted abstract
Background: Cardiac catheterisation plays a vital role in the diagnosis and evaluation of cardiac conditions. The goal of management of patients after cardiac catheterisation is to reduce the risk of development of any local or prolonged vascular complications, in particular bleeding and haematoma formation at the puncture site. Bed rest and immobilisation of the affected leg are recommended practices to ensure adequate haemostasis at the femoral arterial puncture site and prevent complications.

Objectives:
The objective of this review was to present the best available evidence for the optimal length of bed rest after trans-femoral diagnostic cardiac catheterisation. The main outcome of interest was the incidence of bleeding and haematoma formation following varying periods of bed rest.

Search strategy: We searched the following databases: CINAHL, Medline, Cochrane Library, Current Contents, EBSCO, Web of Science, Embase, British Nursing Index, Controlled clinical trials database, Google Scholar. Reference lists of relevant articles and conference proceedings were searched. We also contacted key organisations and researchers in the field.

Selection criteria: All randomised and quasi-randomised controlled trials that compared the effects of different lengths of bed rest following trans-femoral diagnostic cardiac catheterisation on patient outcomes were considered for inclusion in the review.

Data collection and analysis: Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials were assessed independently by two reviewers. Odds ratios (OR) for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, trials were considered separately.

Main results: Eighteen trials involving a total of 4294 participants were included in the review. One trial included three treatment groups. In seven trials among 747 people there was no significant difference in the incidence of bleeding following six or less than 6 h of bed rest (OR 1.47; 95% CI 0.60, 3.64). Likewise, there was no significant difference in the incidence of bleeding following bed rest at other time periods. In eight trials involving 2272 patients there was no significant difference in the incidence of haematoma formation following 6 or less than 6 h of bed rest (OR 0.82; 95% CI 0.59, 1.16). Significantly fewer patients randomised to less than 6 h of bed rest complained of back pain. The odds of developing back pain at 4 (OR 24.60; 95% CI 1.29, 469) and 24 h (OR 2.47; 95% CI 1.16, 5.23) following coronary catheterisation was significantly higher among patients randomised to 6 compared with 3 h of bed rest.

Authors' conclusions: There is evidence of no benefit relating to bleeding and haematoma formation in patients who have more than 3 h of bed rest following trans-femoral diagnostic cardiac catheterisation. However, there is evidence of benefit relating to decreased incidence and severity of back pain and cost-effectiveness following 3 h of bed rest. There is suggestive but inconclusive evidence of a benefit from bed rest for 2 h following trans-femoral cardiac catheterisation. Clinicians should consider a balance between avoiding increased risk of haematoma formation following 2–2.5 h of bed rest and circumventing back pain following more than 4 h of bed rest.
Keyword Cardiac catheterisation
Coronary heart-disease
CHD
Bleeding
Haematoma
Bed rest
Q-Index Code C1
Q-Index Status Confirmed Code

 
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Created: Sat, 18 Apr 2009, 01:05:24 EST by Allison Peacock on behalf of Faculty Of Health Sciences