Angie O’Plasty Casey Jernigan Caroline Stovall Amanda Pitts.
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Transcript of Angie O’Plasty Casey Jernigan Caroline Stovall Amanda Pitts.
The case of
Angie O’Plasty
Casey JerniganCaroline Stovall
Amanda Pitts
The Case50 Year Old African American FemaleDiabetes MellitusHTNHeavy Smoker5’1” 200lbsSedentary lifestyleFamily history of heart problems
The Case: SymptomsUnusual epigastric painNauseaDiaphoreticNeck painStress
The Case: Doctors OrdersEKG Cardiac panelChest X-rayUrinalysisStandard chemistry
CBCTroponinsCreatinine protein
The Case: DiagnosesElevated TroponinsElevated ST segment on EKGDiagnosed with an acute myocardial
infarction (MI)The physician ordered a cardiology consult
and a cardiac catheterizationA double angioplasty was performedA femoral artery access site was closure was
performed with Perclose
Perclosehttp://www.youtube.com/watch?v=NMWzXcU
ZfxA
Situation Focused Question
Is Perclose a more effective closure method than manual compression for a 50 year old female recovering from a femoral artery access heart catheterization?
Targeted ResourcesCOCHRAN PubMedKeywords: PercloseOther key words related to our case study
were unsuccessful
PPAARE Component Case Example
Problem Was the closure method used the best method for closure of femoral artery following angioplasty?
Patient 50 year old, African American woman recovering from a double angioplasty following a myocardial infarction.
Action Watching and observing patient response to procedure and recovery time
Alternative NA
Patient Results That the closure method was the best to reduce risk factors, maintain patient comfort, encourage ambulation
Level of Evidence Peer reviewed articles, controlled studies, and trustworthy organizations publications
Targeted Resources
Relevant Evidence
Relevant Evidence
Relevant Evidence
Course of ActionMonitor the patient for signs that the
Perclose was ineffectiveAdditional Monitoring due to patients risk
factors include:Monitoring signs of infectionMonitoring for the development of blood clotsMonitoring prolonged immobility
•The team would make sure to teach the patient about the risk factors associated with her “heavy smoking” and how that affects her body’s ability to heal.
ConclusionThe EBP team would use the evidence presented and
the knowledge of the patient to provide the best care possible
According to our findings in the research, the EBP team learned that the Perclose closure method was the best method in this case
The evidence found about Perclose stated that it allowed the patient to ambulate up to 2 hours faster than with manual compressions. It also increases hemostasis.
ReferencesAl-Khatib, W.K., Zayed, M.A., Harris, E.J., Dalman, R. L., & Lee, J.T. (2012). Selective use of
percutaneous edovascular aneurysm repair in women leads to fewer groin complications. Annals of Vascular Surgery, 26(4), 476-482. doi: 10.1016/j.avsg.2011.11.026.
Allen, D. S., Marso, S. P., Lindsey, J. V., Kennedy, K. F., Safley, D. M. (2011). Comparison of
bleeding complications using arterial closure device versus manual compression by propensity matching in patients undergoing percutaneous coronary intervention. American Journal of Cardiology, 107(11), 1619-1622. doi:10.1016/j.amjcard.2011.01.049
American Heart Association Staff. (04/04/2012). What about African Americans and high blood
pressure?, Retrieved from http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandYourRiskforHighBloodPressure/High-Blood-Pressure-and-African-Americans_UCM_301832_Article.jsp
Kim, W.H, Shin, S., Ko, Y.G., Hong, M.K., Jang, Y., Choi, D. (2013). Efficacy and safety of the
preclose technique following percutaneous aortic stent-graft implantation. Journal of Endovascular Therapy, 20(3), 350-355, doi: 10.1583/12-4103MR2.1.
St. Jude Medical Staff. (2013). Improve patient comfort after vascular access. Retrieved from
https://clinical.sjm.com/clinical-challenges/hemostasis-management/improve-patient-comfort.aspx