Authors (including presenting author) :
Chan HW, Lam YK, Tsang WM, Tung KL, Chan SP, Law KF, Yue CS, Chung TS, Leung YW, Ng YB
Affiliation :
Department of Medicine and Geriatrics, United Christian Hospital
Introduction :
Previously, traditional compression device (Stepty-P) was applied to arterial wound for haemostasis after transradial cardiac procedure. Several drawbacks were identified: 1) Poor arterial blood flow during device application leads to prolonged haemostasis time, which increased risk of radial artery occlusion. 2) Delayed removal due to unavailability of doctor. In view of that, another compression device, TR band, was introduced which aims at shortening the application time and reducing complications risk. Hence, a protocol was developed and training sessions were performed to standardize nursing management of TR band removal.
Objectives :
1. To shorten the device application time, hence reducing complication risk.
2. To promote nursing competency and autonomy by developing nurse-led TR Band removal protocol.
3. To reduce doctors’ workload on wound management
Methodology :
Protocol development: A weaning protocol was developed and endorsed by CCU consultant. Flowchart and observation chart were also implemented accordingly.
Nurse training: 2-hours lecture and workshop including radial wound management and removal of TR band were organized. Learning material and video were shared on the webpage. Individual audits were performed to assess nurses’ competency.
Data collection: The study was conducted from Dec 2020 to Dec 2021. All patients undergone transradial PCI admitted CCU were recruited. Application time of TR band was measured. Circulation were measured by pulse oximetry waveform, color and temperature.
Result & Outcome :
Nurse training: All CCU nurses have completed and passed the audit.
Data collection: Total 212 patients were recruited. Average TR band application time was 3.75 hours. The hemostatic time was significantly reduced compared with Stepty-P (>5hrs).
>95% cases were assessed and handled by CCU nurses, while only < 4% patients required doctor’s intervention (3% hematoma, < 1% active bleeding). Nurses are proficient and experienced in TR band management. No patient suffered from radial artery occlusion.
Conclusion: Use of TR band significantly reduces hemostatic time and complication risk, as well as minimizes medical workload. In addition, this project has aligned practice and enhanced CCU nurses’ autonomy for caring post PCI patients.
