EARLY MOBILISATION FOLLOWING PERCUTANEOUS TRANSLUMINAL CORONARY
ANGIOPLASTY (PTCA) WITH REOPRO (ABCIXIMAB) ADMINISTRATION E.Currie, B.Dixon and S.Graham*. Mercy Angiography Unit, Mercy Hospital, Auckland, NZ Background: PTCA patients receiving ReoPro are
expected to experience an increased risk of vascular access site (VAS)
complications. Our practice involved removing the femoral sheath approximately
6 hours post Heparin bolus and keeping patients on bedrest for 14 hours total. We proposed to change this practice by
mobilising patients 6 hours from the end of their PTCA. Early mobilisation has
been shown to reduce VAS complications and was expected to increase patient's
comfort, decrease nursing workload and possibly facilitate a shorter hospital
stay. A comprehensive nursing and literature
review found widely differing practices and no definite evidence for the
feasibility and safety of mobilising these patients. Method: We studied six patients who received
ReoPro following PTCA who all had a 6Fg sheath, received 5000units of Heparin
and no other anticoagulants. Patients received 100-150mg Aspirin and 75mg
Clopidogrel concomitantly. The sheath was removed 2 hours post Heparin
bolus employing a Femostop (pressing device) and the patient mobilised 4 hours after
this. They were reviewed for VAS complications in hospital and at one week via
telephone. Results: Access site complication endpoints
include: site bleed, haematoma, pseudoaneurysm, blood transfusion and/or
surgical repair. All six patients were safely mobilised 5 -
61/2 hours post PTCA with no (0%) related VAS complications. This is well below
our VAS complication rate for PTCA without ReoPro. One patient had a haematoma during PTCA prior
to receiving ReoPro. Conclusion: These strongly positive results
showed that early mobilisation is feasible and safe for these patients and
therefore we have changed our nursing practice for all patients receiving
ReoPro, not just for those meeting our study criteria, e.g; patients receiving
a higher Heparin dose. Further study could be conducted to
distinguish the relationship between the low dose Heparin and the use of the
Femostop, with ReoPro use.
