A randomized controlled trial assessing the use of compression versus vasoconstriction in the treatment of femoral hematoma occurring after percutaneous coronary intervention

• Published in: Heart & lung 2008-05, Vol.37 (3), p.205-210
• Main Authors: King, Nicola A., Dip HE, MSc, RGN, Philpott, Samantha J., BSc Hons, RN, Leary, Alison, PhD, RN
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Attitude of Health Personnel; Cardiac Catheterization - adverse effects; Cardiac Catheterization - methods; Cardiovascular; Coronary Angiography - adverse effects; Coronary Angiography - methods; Critical Care; Cryotherapy; Female; Femoral Artery - pathology; Femoral Artery - surgery; Hematoma - etiology; Hematoma - pathology; Hematoma - therapy; Hemostasis, Surgical - methods; Humans; Male; Middle Aged; Patient Satisfaction; Postoperative Hemorrhage - etiology; Postoperative Hemorrhage - pathology; Postoperative Hemorrhage - therapy; Pressure; Pulmonary/Respiratory; Statistics, Nonparametric; Surveys and Questionnaires; Treatment Outcome; Vasoconstriction - physiology
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2007.05.008

Background The aim of this study was to identify the optimal management of femoral hematoma occurring after coronary angiography and intervention. These procedures carry little risk; however, femoral hematoma is a commonly reported complication, which other studies have suggested is under reported. The objective of this study was to compare the current anecdotal standard practice use of compression in the form of sandbag application with local cold-mediated vasoconstriction in the form of cold-pack application as a clinically more effective and well-tolerated treatment of femoral hematoma. Methods Patients who developed femoral hematoma with a surface area of ≥30 cm2 after cardiac catheterization were included in the study (n = 50). Participants were randomly allocated to cold-pack therapy (vasoconstriction trial) or to sandbag (compression-control) application and provided consent before the procedure. Each hematoma was measured at 30-minute intervals during a period of 3 hours. Patient and staff satisfaction were also assessed using a questionnaire. Results A significant difference was observed between the 2 groups, with vasoconstriction (cold-pack application) being more effective in rate of reduction of haematoma (confidence interval 95% P < .05). The current practice of sandbag therapy does not provide the most clinically effective patient care according to these data. Conclusions Cold-pack therapy is not currently recognized as a standard practice to treat this complication, yet it is more effective than compression and acceptable to patients. The expansion of this study would seek to contribute to the implementation of evidence-based practice.