الفهرس 
Anatomy and Physiology of the Cardiovascular SystemOnly 14 pages are availabe for public view
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Abstract
Vascular access site complications (VASCs) related to femoral artery remain an important source of increased morbidity, mortality, length of stay and cost. Incidence of VASCs post diagnostic CA includes: hematoma, retroperitoneal hematoma, arterial venous fistula, pseudo-aneurysms, acute limb ischemia/acute arterial thrombosis. This incidence of complications increases with PCI, as it requires potent use of oral and intravenous antiplatelet and anti-thrombin medications which increase the effectiveness of PCI, but it is also accompanying with an increased risk of VASCs (Gurzu & Jung, 2017).
There are three methods are employed to achieve femoral artery hemostasis following sheath removal after cardiac catheterization, they are the manual compression, mechanical compression and vascular closure devices. Manual compression has been the gold standard for obtaining hemostasis at the vascular access site for years, but this standard has changed as new devices have come on the market (Goswami et al., 2016).
Manual compression for some practitioners is not an option because it requires strength and the ability to hold a good compression for 15 to 20 minutes and if hand and arm fatigue develops during the procedure, the amount of pressure applied to the femoral artery may vary causing vascular access site complications and it requires also long time for hemostasis and long term for ambulation after achieving hemostasis )Batiha et al., 2016)..
The present study was conducted to fulfill the following aims:
1- Compare the effect of using manual compression and mechanical compression technique in achieving hemostasis after femoral sheath removal through:
a- Assessment of the time to hemostasis using manual and mechanical compression.
b- Assessment of time to ambulate from bed after sheath removal.
c- Assessment of patient comfort level using numeric rating pain scale (0-10) after using manual and mechanical compression methods.
2- Compare the effect of using manual and mechanical compression technique on patient vascular complications through:
a- Assessment of hematoma formation.
b- Assessment of ecchymosis formation.
c- Assessment of oozing (bleeding).
d- Assessment of skin integrity.
Research question:
This study was conducted for answering the following research question:
What is the most effective method for achieving femoral artery hemostasis after coronary catheterization?
Research design:
A comparative study design was used to conduct this study.
Research setting:
This study was conducted in the cardiac catheterization unit at Beni-Suef general hospital and Beni-Suef university hospital.
Research subjects:
A purposive sample of 121 patients (69 patients underwent CA and 52 underwent PCI) admitted to the previous mentioned settings at the time of data collection were recruited in this study.
Tools for data collection:
Three tools for data collection were used as follows:
I. Patients interview questionnaire tool.
II. Femoral artery hemostasis measuring scales.
III. Patients’ vascular complications monitoring scales.
I. Patients Interview questionnaire tool:
This tool was developed by the researcher in English language. It was written based on reviewing of related literatures.
It includes two parts:
Part 1: Patient’s demographic characteristics:
It aimed to assess the patients’ socio-demographic characteristics such as age, gender, occupation, marital status, level of education, residency, and health insurance coverage.
Part 2: patients clinical data: it was used to assess and collect data about patients’ medical history which included present, past and family health history such as weight, height, BMI, abdominal and pelvic girth, vital signs, laboratory investigations (INR, serum creatinine), presence of chronic diseases, current medications, past surgical history and presence of family history of cardiovascular disease.
II. Femoral artery hemostasis measuring scales that include:
1. Hemostasis time using manual and mechanical compression.
2. Time to ambulate from bed after sheath removal.
3. Patient comfort level scale using numeric rating pain scale (0-10) after using manual or mechanical compression methods.
III. Patients’ vascular complications monitoring scales:
This tool includes 4 scales as follows:
1- Hematoma formation scale.
2- Ecchymosis formation scale.
3- Oozing (bleeding) scale.
4- Skin integrity scale.
The important findings obtained from the current study can be summarized as the following:
- For the Hemostasis time, 77.0% of patients were achieved hemostasis within 5 to < 10 minutes when using the CRoC compressor, while 38.5% of patients when using the manual compression method in the same period of time.
- For the pain, level the manual group had higher score of pain at time of sheath removal, while at the other three assessment times (5, 10, 20 minutes), the patients in the compressor group had the lower score of pain as P value (0.006, 0.005, 0.02) respectively.
- For hematoma formation in the reassessment after 3 hours, 53.0% of patients who experienced small hematoma formation were in the manual compression group, while 28.6% of patients when using the CRoC compressor.
- For the ecchymosis formation, 19.3% of patients in the manual compression experienced small ecchymosis formation immediately after sheath removal while none of patients experienced any Ecchymosis formation in the CRoC compressor group.
- For skin integrity 91.4% of patients underwent coronary angiography who didn’t experience any skin integrity impairment immediately after sheath removal were in CRoC Compressor group, while 70.6% of patients when using the manual compression.