经桡动脉造影和介入治疗后桡动脉闭塞的预防:最佳实践实施项目。

IF 2.7 4区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Jbi Evidence Implementation Pub Date : 2024-10-10 DOI:10.1097/XEB.0000000000000463
Biyun Xia, Pinfang Song, Alexa McArthur, Jiaojiao Bai
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引用次数: 0

摘要

导言:在经桡动脉入路的相关并发症中,桡动脉闭塞(RAO)是最常见、最严重的并发症,它限制了同一桡动脉在后续手术中的再次使用,也限制了同一桡动脉作为冠状动脉旁路移植术的移植物:本项目旨在实施最佳实践,降低 RAO 的发生率,从而提高经桡动脉冠状动脉造影或介入治疗后的患者护理质量:该项目在中国上海华东医院心内科开展。方法:该项目在中国上海华东医院心内科开展,采用七阶段 JBI 证据实施框架来指导项目。项目制定了八项审核标准,并进行了基线审核,以比较当前的 RAO 预防实践与最佳实践。在实施改进策略后,又进行了一次后续审核,以评估这些策略是否成功:结果:实施最佳实践后,在缩小鞘/导管尺寸和出院前系统评估桡动脉通畅性方面取得了显著改善,两项标准的达标率均为100%。预防性尺动脉加压的使用率从 0% 提高到 90%,最小压力策略的采用率从 0% 提高到 70%。穿刺前和术后止血硝酸酯的使用率也从 23% 提高到 93%。实施的障碍包括缺乏预防性尺动脉压迫的专用设备、移除压迫设备后可能出血、缺乏循证护理工作流程以及缺乏预防 RAO 的护理评估记录表:该项目促进了护士对经桡动脉血管造影和介入治疗后 RAO 患者的循证护理实践。今后应努力保持最佳实践。西班牙文摘要:http://links.lww.com/IJEBH/A261。
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Prevention of radial artery occlusion after transradial angiography and intervention: a best practice implementation project.

Introduction: Among the complications associated with transradial artery access, radial artery occlusion (RAO) is the most frequent and serious, limiting the reuse of the same radial artery for subsequent procedures and as a graft for coronary artery bypass grafting.

Objective: The objective of this project was to implement best practices to reduce the incidence of RAO, thereby enhancing the quality of patient care after transradial coronary angiography or intervention.

Methods: The project was conducted in cardiology department of the Huadong Hospital, Shanghai, China. The seven-phase JBI Evidence Implementation Framework was used to guide the project. Eight audit criteria were developed and a baseline audit was conducted to compare current practice with best practices for RAO prevention. Following the implementation of improvement strategies, a follow-up audit was conducted to evaluate the success of the strategies.

Results: The implementation of best practices led to significant improvements in reducing the sheath/catheter size and systematically assessing radial artery patency before discharge, with both criteria reaching 100% compliance. The use of prophylactic ulnar compression increased from 0% to 90%, and the adoption of a minimal pressure strategy improved from 0% to 70%. The use of pre-puncture and post-procedural pre-hemostasis nitrates also increased from 23% to 93%. Barriers to implementation included the lack of dedicated devices for prophylactic ulnar artery compression, the possibility of bleeding after removal of the compression device, absence of an evidence-based care workflow, and absence of nursing assessment record forms for RAO prevention.

Conclusions: This project promoted evidence-based practices among nurses for the care of RAO patients following transradial angiography and intervention. Efforts should be made to sustain the best practices in the future.

Spanish abstract: http://links.lww.com/IJEBH/A261.

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23
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