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

Manual Compression

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