ASPAN National Conference Abstracts

RESEARCH POSTER ABSTRACTS

POST ANESTHESIA PATIENTS WITH LARGE UPPERARM CIRCUMFERENCE: IS USE OF AN “EXTRA-LONG” ADULT CUFF OR FOREARM CUFFPLACEMENT ACCURATE?Primary Investigator: Sheri Watson, BSN, RN, CPAN

Providence Portland Medical Center, Portland, Oregon

Co-Investigators: Marita Aguas, CNL, MS, BSN, RN, CCRN, CPAN,

Tracy Bienapfl, RN, Pat Colegrove, BSN, RN,

Larissa Ellis, BSN, RN, Nancy Foisy, BSN, RN,

Bonnie Jondahl, BS, RN, Mary Beth Yosses, MS, BSN, RN,

Zoe Anastas, MPH, BSN, RN-BC, PCCN

National guidelines for blood pressure (BP) measurement recom-

mend use of the upper arm for BP cuff placement. Clinicians

sometimes use the forearm location for placement of the BP

cuff in patients with large arm circumferences when the correct

BP cuff size for upper arm BP is not available. The purpose of

this studywas todetermine if bloodpressures obtained in the fore-

arm or with an extra-long BP cuff in the upper arm accurately

reflects BP measured in the upper arm with an appropriately

sized BP cuff in patients with large upper arm circumference. A

method-comparison study design was used, with each subject

serving as his or her own control. In a convenience sample of

PACU patients, noninvasive blood pressures were obtained in

two different locations (forearm; upper arm) and in the upper

arm with an extra-long adult and recommended large adult cuffs.

The same arm was used for each measurement with the time be-

tween measurements based on the American Heart Association

(AHA) recommendations. Data were analyzed by calculating

bias and precision for the BP cuff size and location and Student’s

t tests, with P , .0125 considered significant. Forty-nine post-

anesthesia patients participated in the study. Significant differ-

ences were found between forearm and upper arm systolic

(P, .0001) and diastolic (P, .0002) BP measurements. Signifi-

cant differences were found between the systolic BP measured

with theextra-longcuff at theupper arm site compared to theup-

per arm, reference standard BP (t48df5 5.38, P, .0001) but not

for the diastolic BP (t48df5 4.11,P, .019). Themagnitude of the

discrepancies inBPmeasurement foundwith the forearmcuff lo-

cation and the upper arm, extra-long cuff compared to the AHA

recommended upper arm, proper-sized BP cuff could lead clini-

cians to incorrectly identify ormiss hypotension or hypertension

in PACU patients, predisposing them to serious complications.

Further studies should be done in order to determine accurate

blood pressure measurement in this population of patients.

COMPARISONOFMANUALCOMPRESSIONANDTHEUSE OF THE HEMOSTATIC PATCH (SYVEKPATCH)FOLLOWING CORONARYANGIOGRAPHYPROCEDURES IN PATIENT SATISFACTION,NURSING PRODUCTIVITYAND COSTPrimary Investigator: Joan Fox, RN

Co-Investigators: Alaina Cyr, BSN, RN, CAPA, NE-BC,

Linda Tjiong, MSN, DBA, RN, NE-BC,

Kristi Verschelden, RN, Erin Weaver, BSN, RN

Journal of PeriAnesthesia Nursing, Vol 26, No 3 (June), 2011: pp 199-202

Femoral sheath removal followed by compression of the femo-

ral artery after a coronary angiography for diagnostic and inter-

vention procedures is a nursing responsibility across many

hospital settings (Chlan, Sabo, Savik, 2005). Several methods ex-

ist for achieving hemostasis of the femoral artery after the dis-

continuation of the sheath. Nurses can use manual pressure

alone, manual pressure and a compression device such as Femo-

stop, or manual pressure and utilizing hemostasis patch such as

SyvekPatch. The purpose of this quasi-experimental, random-

ized studywas to compare the effects of two groin compression

methods: manual compression and manual compression with

a hemostatic patch (SyvekPatch) on patient comfort, time to he-

mostasis, duration of bed rest, length of stay and cost of care.

There were no significant differences in pain scores between

the manual and hemostatic patch groups using the Numeric

Rating Pain Scale (r 5 .80). A statistical significant was found

regarding pressure time between the two groups with the he-

mostatic patch group having a lower pressure time (t 5 2.95,

P # .004). However, no clinical significance was found as the

mean times differed by only 3.34 minutes, and with one outlier

removed the mean times only differed by 2.5 minutes. The

mean pressure time for manual compression was 14.74

(N 5 39, AD 7.159) and the mean pressure time using hemo-

static patch was 11.40 (N5 50, SD 3.201). The actual duration

of bed rest was determined based on physician order with

manual compression group on bed rest 1-2 hours longer than

the hemostatic patch group. There was no difference in the

length of stay between the two groups or a change in the staff-

ing level. There was no cost saving related to labor; however,

the patch has a cost of $76/unit with a usage of 873 per year

at facility yielding a potential cost savings of $68,500 per year.

References: Chlan LL, Sabo J, Savik K. Effects of three groin com-

pression methods on patient discomfort, distress, and vascular

complications following a percutaneous coronary intervention

procedure. Nursing Research. 2005;54:391-398.

SHOULD HUMIDIFIED OR NON-HUMIDIFIEDOXYGEN ROUTINELY BE USED FOR ADULT POSTANESTHESIA PATIENTS IN THE POST ANESTHESIACARE UNIT (PACU)?Susan Cooper, BSN, RN, CPAN

Texas Health Presbyterian Hospital Dallas, Dallas, Texas

Introduction:Weneed to question tradition-based practices to

improve patient care and outcomes. In our Post Anesthesia Care

Unit (PACU), we routinely use humidified oxygen for our pa-

tients. Nurses currently change multipatient humidifiers daily.

Due to infection concerns, we will soon be using single use hu-

midifiers and will change those for each patient.

Problem Identification: Use of humidified oxygen is costly in

terms of staff time and equipment. Patients complain about the

discomfort of humidified oxygen.

Purpose:To determine if low flownon-humidified nasal cannu-

las or face masks could be used for non-intubated PACU patients

without adversely affecting patient outcomes.

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