| Nurses care for nearly a million people in the United States undergoing percutaneous coronary interventions (PCI) annually. Femoral artery vascular complications are known to occur in approximately three percent of these procedures; thus, involving 30,000 people per year.; A descriptive, comparative, case-matched control design was used to study risk predictors for vascular complications in 300 adult patients who underwent PCI, January 2001 to June 2005 (HIC # 11978). The research questions were: (1) which variables: (A) co-morbidities (body mass index, diabetes mellitus, history of hypertension, renal failure), (B) physician sensitive (anticoagulants, hemostasis method, venous sheath), and (C) nurse sensitive (time in bed [TIB], mean systolic blood pressure during PCI [MSBPDP], mean systolic blood pressure during sheath removal [MSBPSR], mean systolic blood pressure during recovery [MSBPREC]) are significant predictors of vascular complications, and (2) what percent variance in prediction of complication are accounted for by nurse sensitive variables, after controlling for co-morbid and physician sensitive variables? A secondary aim was to determine if the continuous variable, creatinine clearance, is a better predictor of vascular complications than renal failure (yes, no).; Seventy-three percent of the vascular complications occurred within two hours of the procedure. Therefore, MSBPREC and TIB could not be considered predictors and were excluded from the regression analysis. Of 280 patients, in this study, those with MSBPDP of 160 mm Hg, or higher, were eight times more likely to have vascular complications (p < 0.001). Patients receiving heparin (with and without GP IIb/IIIa inhibitors) versus bivalirudin, were three times more likely to have vascular complications ( p = 0.008). Patients with hemostasis by Angio-Seal and those with a history of hypertension were 77% (p = 0.031) and 61% ( p = 0.005), respectively, less likely to have complications. Other co-morbid conditions, including creatinine clearance, were not significant.; The results indicate that nurses should provide more conservative protocols of care for patients with systolic blood pressures greater than 160 mm Hg and receiving heparin and GP IIb/IIIa inhibitors. A diagnosis of co-morbid conditions does not necessarily increase the risk of vascular complications. More specific methods of identifying high risk patients are needed. |
