Coronary angiography observations: Evidence-based or ritualistic practice?

OBJECTIVE: The purposes of this study were to describe the incidence and oc currence of femoral artery bleeding during the first 6 hours after coronary angiography and to determine whether there is a relationship between curre nt postangiogram observation protocols and the detection of complications. DESIGN: This was a prospective descriptive study. SETTING: The study was conducted in 3 university hospitals in Melbourne, Au stralia. PATIENTS: Subjects included 55 patients representing the complication rate of 1075 patients, mean age 61 years (SD, 12), 69% male. RESULTS: About 5.1% of patients had 1 or more incidents of bleeding requiri ng manual compression. In 4.2% of patients, bleeding occurred within 6 hour s of angiography. Bleeding occurred a median of 2.02 hours (Q1 = 45 minutes , Q3 = 4.31 hours) after angiography. Patients without pressure bandaging b led a median of 1.32 hours (Q1 = 36.50 minutes, Q3 = 2.59 hours) after angi ography. Patients with pressure bandaging bled a median of 4.75 hours (Q1 = 2.25 hours, Q3 = 7.28 hours) after angiography. In 40.6% of cases, bleedin g was detected through the patient's call for assistance, and in 59.4% of c ases nurses noted bleeding while checking the puncture site. Postcatheter o bservations were recorded 23.70 (SD, 14.60) minutes before the bleeding inc ident. There were no significant changes in vital signs, systolic blood pre ssure (P > .05), diastolic blood pressure (P > .05), or pulse (P > .05) bef ore or during a bleeding episode. All were within normal parameters. No neu rovascular assessment anomalies were detected. CONCLUSION: The use of pressure bandaging has a significant effect on the i ncidence and pattern of bleeding. Routine vital sign measurement has no rel evance in detecting local complications after angiography. The most signifi cant complication is bleeding that requires manual compression. Detection i s through frequent puncture site observation and patient recognition and co mmunication.