2.50
Hdl Handle:
http://hdl.handle.net/10755/157047
Category:
Abstract
Type:
Presentation
Title:
Activity Restriction After Temporary Epicardial Pacing Wire Removal: Does It Matter?
Author(s):
Schofield, Judith
Author Details:
Judith Schofield, RN,BS,MSN, The Christ Hospital, Cincinnati, Ohio, USA, email: judith.schofield@thechristhospital.com
Abstract:
POSTER PURPOSE: To assess the complication rate related to patient activity level after removal of temporary epicardial pacing wires in cardiac surgery patients. Specifically, the study examined complications in patients randomized to either 30 minutes of bed rest or no bed rest restrictions after wire removal. In phase 1, only patients who were not taking heparin or warfarin were included in the study. Phase 2 mirrored the first phase but included patients taking only warfarin. BACKGROUND/SIGNIFICANCE:Patients undergoing cardiac surgery routinely have epicardial pacing wires placed during surgery for postoperative monitoring of dysrhythmias and to provide temporary pacing if needed. Registered nurses (RNs) routinely care for patients with these wires and remove the wires before discharge. Theoretically, removal of epicardial wires can result in dysrhythmias, bleeding, or cardiac tamponade. RNs based activity level after removal on "the way they were taught" instead of on scientific data, resulting in inconsistent practice. METHOD: A prospective experimental design was used to answer the research questions. In phase 1, all adult patients who were not taking warfarin/heparin were invited to participate in the study. After consent was obtained, patients were randomized to a group that got 30 minutes of bed rest or a group that got no bed rest. Specially trained cardiac care nurses removed the epicardial wires per standard protocol. Cardiac rhythm monitoring continued after removal of the wires. Patients were assessed for bleeding, dysrhythmias, or signs of cardiac tamponade. After collection and analysis were completed for phase 1 and safety was ensured, phase 2 was started, using the same protocol on patients who were prescribed warfarin. RESULTS: A sample of 59 people were recruited for phase 1 and the groups did not differ significantly in age, weight, or height (P > .05). In the first phase, only 2 patients had possible complications and both were in the bed rest group. One patient complained of nausea before and after wire removal, and a second patient reported slight dizziness. No patients in the immediate mobilization group reported an adverse event. In phase 2, sixty subjects were randomized to bed rest or no bed rest. Sample demographics were similar to those in phase 1 but all patients were taking warfarin and the mean international normalized ratio was 1.8. No adverse events occurred in any of the patients in phase 2. CONCLUSIONS: Because there were no adverse effects in either phase of the study, a new evidence-based protocol was developed that included no limitation of activity after removal of epicardial pacing wires. With a process in place that is supported by RNs and physicians, patients receive consistent quality treatment with no decrease in safety or outcomes. A secondary result of the study was a decrease in length of stay. Six months after initiation of the protocol, no adverse effects have been reported.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleActivity Restriction After Temporary Epicardial Pacing Wire Removal: Does It Matter?en_GB
dc.contributor.authorSchofield, Judithen_GB
dc.author.detailsJudith Schofield, RN,BS,MSN, The Christ Hospital, Cincinnati, Ohio, USA, email: judith.schofield@thechristhospital.comen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157047-
dc.description.abstractPOSTER PURPOSE: To assess the complication rate related to patient activity level after removal of temporary epicardial pacing wires in cardiac surgery patients. Specifically, the study examined complications in patients randomized to either 30 minutes of bed rest or no bed rest restrictions after wire removal. In phase 1, only patients who were not taking heparin or warfarin were included in the study. Phase 2 mirrored the first phase but included patients taking only warfarin. BACKGROUND/SIGNIFICANCE:Patients undergoing cardiac surgery routinely have epicardial pacing wires placed during surgery for postoperative monitoring of dysrhythmias and to provide temporary pacing if needed. Registered nurses (RNs) routinely care for patients with these wires and remove the wires before discharge. Theoretically, removal of epicardial wires can result in dysrhythmias, bleeding, or cardiac tamponade. RNs based activity level after removal on "the way they were taught" instead of on scientific data, resulting in inconsistent practice. METHOD: A prospective experimental design was used to answer the research questions. In phase 1, all adult patients who were not taking warfarin/heparin were invited to participate in the study. After consent was obtained, patients were randomized to a group that got 30 minutes of bed rest or a group that got no bed rest. Specially trained cardiac care nurses removed the epicardial wires per standard protocol. Cardiac rhythm monitoring continued after removal of the wires. Patients were assessed for bleeding, dysrhythmias, or signs of cardiac tamponade. After collection and analysis were completed for phase 1 and safety was ensured, phase 2 was started, using the same protocol on patients who were prescribed warfarin. RESULTS: A sample of 59 people were recruited for phase 1 and the groups did not differ significantly in age, weight, or height (P > .05). In the first phase, only 2 patients had possible complications and both were in the bed rest group. One patient complained of nausea before and after wire removal, and a second patient reported slight dizziness. No patients in the immediate mobilization group reported an adverse event. In phase 2, sixty subjects were randomized to bed rest or no bed rest. Sample demographics were similar to those in phase 1 but all patients were taking warfarin and the mean international normalized ratio was 1.8. No adverse events occurred in any of the patients in phase 2. CONCLUSIONS: Because there were no adverse effects in either phase of the study, a new evidence-based protocol was developed that included no limitation of activity after removal of epicardial pacing wires. With a process in place that is supported by RNs and physicians, patients receive consistent quality treatment with no decrease in safety or outcomes. A secondary result of the study was a decrease in length of stay. Six months after initiation of the protocol, no adverse effects have been reported.en_GB
dc.date.available2011-10-26T19:22:27Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:22:27Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.