Authors (including presenting author) :
Chan HW, Lam YK, Tsang WM, Tung KL, Chan SP, Law KF, Yue CS, Chung TS, Leung YW, Ng YB
Affiliation :
(1) Coronary Care Unit, United Christian Hospital
Introduction :
The transradial approach for Percutaneous Coronary Intervention (PCI) is commonly used in cardiac unit due to lower complication risks and patient’s satisfaction. Traditionally, the Stepty-P device comprising an adhesive bandage and compression pad has been applied for radial arterial site haemostasis. However, several drawbacks are identified:
1) Poor arterial blood flow during application resulting in prolonged haemostasis time and pain.
2) Delayed removal due to unavailability of doctor.
In order to achieve better patient outcomes, the TR band was introduced, allowing consistent arterial blood flow during haemostasis. Optimal compression force can be maintained without compromising blood flow. A standardized protocol was developed, and nurses were trained to manage TR band removal independently.
Objectives :
Objectives
1. To reduce patients’ discomfort by shortening device application time.
2. To develop a standardized protocol for TR band removal.
3. To enhance nursing competency and autonomy in post PCI care.
4. To reduce doctors’ workload in wound management.
Methodology :
I) Protocol development: A weaning protocol was developed, involving gradual deflation starting 2 hours post procedure until full removal. A flowchart and observation chart were introduced.
II) Nurse training: A 2-hour lecture and workshop covering radial wound management and TR band removal were conducted. Learning material and video were also shared online. Nurses’ competency was assessed by individual audits.
III) Data collection: From Dec 2020 to Dec 2021, data from 212 patients undergoes PCI were collected. TR band application time, circulation and sensation in the affected limb were recorded.
Result & Outcome :
I) Nurse training: All CCU nurses have completed and passed the audit. 6 nurses are qualified trainers.
II) Data collection: Average TR Band application time was 3.75 hours. The haemostatic time was significantly reduced compared with Stepty-P which is over 5 hours.
III) CCU nurses are proficient in assessing and handling these cases while 4% patients required doctor’s intervention (3% hematoma, 1% active bleeding). 25%, 9% and 18% of patients complained wound pain, numbness and tightness respectively.
