Evidence Based Practice Step by Step
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Transcript of Evidence Based Practice Step by Step
EVIDENCE BASED PRACTICE STEP BY
STEPTammy Chandler RN MSN ACNS,
BCJune 8, 2015
Step by Step Knowledge Focused Triggers 1. New Research 2 National Agencies Is it a poritity? Yes, it a priority to the cath lab because
we have a lot of problem with beds within the hospital.
Terumo Band(TR) New Director of the Cardiac
Catheterization lab Planning session New protocol Gathering a team Researching the literature
Searching the literature for advantages to radial
RADIAL Dual blood supply which
limits the potential for limb threatening ischemia
• Advantageous for patients with severe occlusive aortoiliac disease
Advantageous for patients with difficulty laying/lot (back pain, obesity, CHF)
• The vessel is easily compressible
• Less chance for local nerve injury
• Less chance for local nerve injury
• Radial approach allows earlier patient ambulation and likely will cost less (closure devices are not necessary)
• Vascular complications are less frequent (1, 8-10)
• Randomized trials to date suggest patients prefer the radial approach
Searching the literature to the advantages of the groin
Long history of use • Technically easy • Facilitates the use of larger
catheters/equipment
Phrasing the question In patients undergoing cardiac
catheterizations would radial access be advantageous to patients or would the groin be appropriate ?
Category 1 We look at the strength of evidence conclusions of the study are valid and strongly supported by the study designs analysis is the risk.
Allen’s Test The Allen Test should be documented on
every patient when preparing to obtain radial access.
To perform the Allen’s test occluding of the radial and ulner arteries should be performed then the ulner artery is released.
Abnormal Allen test noted is when the coloring doesn’t return within 8 seconds.
Research supports the allen’s test.
Patient Received Less Than 5,000 units of
Heparin
Patient Received Greater Than 5,000 units of Heparin or
Angiomax__ cc inflated @ ___________ __ cc inflated @ ___________
30 min: 3 cc down @ _____________ 1 Hour: 3 cc down @ ____________
5 min: 3 cc down @ ______________ 30 Min: 3 cc down @ _____________
5 min: 3 cc down @ ______________ 5 min: 3 cc down @ ______________
5 min: 3 cc down @ ______________ 5 min: 3 cc down @ ______________
5 min: 3 cc down @ ______________ 5 min: 3 cc down @ ______________
Total deflated @ ___________ Total deflated @ ___________
Test pilots of change initially in the post
anesthesia care unit (PACU) and then as we
progressed we utilized theCICU.
Revisions Time Interval Procedure End (Time: )
15 min vital signs ( Time: )
15 min vital signs (Time: )
5 min (Time: )
5 min (Time: )
5 min (Time: )
Patient Received Less Than 5,000 units of Heparin
__ cc inflated @ ___________ HR:______ Blood Press____
HR:______ Blood Press____ 30 min: 3total compression: 3 cc
down @ _____________ 5 min: 3 cc down @ ______________ 35
min total compression:
5 min: 3 cc down @ ______________ 40 min total compression 5 min: 3 cc down @ ______________ 45 min total compression Repeat the cycle until completed
without any bleeding Total deflated @ ___________
CompetencyTASK Met Not Met Method of Verification
1. Verbalizes the Policy and Procedure for TR Band Care
2. Verbalizes the procedure to the patient
3. Identifies the necessary equipment for care
4. Verbalizes the proper air removal process
5. Can perform the re-inflation procedure
6. Identifies the maximal air inflation amount
7. Can identify signs of hemostasis prior to TR Band removal
8. Can state three signs relating to decreased perfusion to the distal extremity
TASK Met Not Met Method of Verification
9. Verbalizes patient education points with follow-up care
10.Verbalizes the need to evaluate the access site and distal extremity while the TR Band is in place
11. Recognizes the need for immobilization of the wrist.
12. Notes any adverse response to treatment
13. Documents the procedure in patient’s record.
14. Can perform a reverse modified Barbeau test
Post Procedure Care Check for capillary refill, sensitivity, temperature, and pulse
oximetry tracing of affected site If site oozes, inflate the TR Band with 1-2 cc of air or more to
prevent oozing When TR Band is deflated and no bleeding is noted, remove TR
Band and apply a Tegaderm occlusive dressing. Additionally an Ace Wrap/wrist support device at the site may be utilized.
Instruct patient not to bare weight on procedure site for 72 hours.
Blood pressure or blood drawn to affected arm for 24 hours. Do not submerge hand for 5 days (no tub bath, no swimming,
no dish washing) Instruct the patient to watch for signs of infection, redress,
swelling, fever
Conclusions Is the change appropriate for adoption
into practice monitor and analyze strategies and potential outcomes.
Policy will have to be made to reflect this practice change.
Leading to same day post coronary interventions.