Implementation of an evidence based sheath removal protocol to decrease rates of post-PCI bleeding complications
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Authors
Christensen, Stephanie
Issue Date
2019-05-18
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Abstract
Purpose: The purpose of this quality improvement project was to implement a standardized sheath removal protocol for adult patients undergoing percutaneous coronary intervention.|Background: Bleeding is the most common non-cardiac PCI complication. Several studies have demonstrated that bleeding complications following PCI are associated with increased short- and long-term risk of morbidity and mortality. Quality improvement recommendations specific to PCI bleeding complications have been developed. There is a need for increased utilization of these recommendations to decrease rates of PCI bleeding complications.|Setting: The setting included the Heart and Vascular Institute (HVI), cardiac catheterization lab, and post-anesthesia care units (PACU) at CHI Health CUMC Bergan Mercy in Omaha. The sample included adult patients who had undergone PCI at the facility as well as nursing staff in the cath lab, PACU and HVI.|Methods: Rates of post-PCI bleeding complications were compared pre- and post-implementation of a sheath removal protocol. Further, assessment of nursing staff knowledge and confidence regarding appropriate sheath removal methods was conducted.|Results: There was an observed decrease in the rate of post-PCI bleeding complications following protocol implementation; pre-implementation rate was 4.6% (8 out of 172) and post-implementation rate was 3.1% (2 out of 64). A statistically significant increase in nursing staff knowledge of appropriate sheath removal methods was also observed.|Conclusion: There is a need for increased utilization of evidence-based sheath removal methods to aid in decreasing rates of post-PCI bleeding complications. Utilization and education regarding the NCDR Sheath Removal Protocol has proven to be effective at decreasing rates of post-PCI bleeding complications. Further education and research surrounding methods to decrease post-PCI bleeding complications are warranted.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University