I chose to look up information on the use of vascular closure devices (Angio-Seal) versus the use of manual pressure following a percutaneous coronary intervention or a CATH procedure. This is a discussion that I had in clinical recently with Lisa. We discussed the use of the Angio-Seal and how it isn’t seen as often. I believe it is preference of the Doctor doing the procedure. According to Gregory, Midodzi, and Pearce (2013) there has been conflicting data about whether the VCD’s decrease, increase, or do not alter the risk of access site complications. The authors had 11, 897 participants. 7, 063 participants received an angio-seal VCD and 4, 834 did not. There were two samples; in the CATH sample 4,845 received a VCD and 4, 030 did not. In the PCI sample, 804 did not receive a VCD and 2, 218 did receive a VCD. Vascular complications rates were lower with both sample groups with the use of VCD. The authors found that the use of VCDs have been associated with earlier ambulation and improved comfort. However, manual compression has been the “gold” standard for 60 years and remains a controversy in whether or not there is any more of a benefit with the use of VCDs. Overall, a low incidence of vascular complications were observed with the use of VCD (angio-seal) in comparison to manual compression (Gregory, Midodzi, & Pearce, 2013).

I found this article interesting and will look further into more research. Because of patient privacy I have chosen not to talk about my situation in clinical with an Angio-Seal versus manual compression.

References

Gregory, D., Midodzi, W., & Pearce, N. (2013). Complicaitons with Angio-Seal vasuclar closure devices compared with manual compression after diagnostic cardiac catheterization and percutaneous coronary intervention. Journal of Interventional Cardiology , 26 (6), 630-638.

 

In researching for this assignment, I came across two articles of interest, one that describes attitudes of geriatric individuals on mobile health technologies in association with warfarin therapy, and the other article sought to determine (through literature review), which telehealth methods were most effective for medication adherence and improving clinical outcomes (Granger & Bosworth, 2011; Lee et al., 2014). These telehealth methods include automated alerts sent through cellphone texting capability to remind patients to take their daily medications, refill reminders, nursing education audio-recorded and sent to patients, and digital medication reconciliation) (Granger & Bosworth, 2011). The reason that I wanted to read both articles is because when we talk about technology, which is easily accessible and somewhat simple to maneuver for many people, there are a few populations that we must consider as we move forward with these up-and-coming technological advancements in nursing education and patient support. 1) Our geriatric patients may be intimidated by unfamiliar technology and as mentioned in the article, require a great deal of support and positive reinforcement from both the healthcare professional and their family in order to be successful and consistent in using telehealth (such as cellphone automated alerts for medication administration reminders, etc.) (Lee et al., 2014). As nurses, we need to be conscientious of individual needs and remember that we feel the same way when we are trying to learn something new. 2) Low-income populations do not have the same access to technology that many of us take for granted; while medication adherence is a significant public health problem due to the prevalence of cardiovascular-related conditions such as uncontrolled diabetes mellitus and heart failure, individuals without financial means to even purchase their medications may not have the means to own an expensive phone to engage in some of the newer technology that improves medication adherence. Therefore, creativity is needed to reach out to both these populations. The best results in regards to medication adherence and improved clinical outcomes were those that combined mobile reminders and face-to-face interaction; methods that only used mobile phone reminders did not improve adherence or outcomes (Granger & Bosworth, 2011). Therefore, our challenge is to find the best way to help patients gain access both to personal care, and new technology such as automated medication reminders in order to improve their outcomes and quality of life; what is wonderful about nursing is that we can continue to practice in the best of both worlds by incorporating technology into our personal nursing care.

References:

Granger, B. B. & Bosworth, H. (2011). Medication adherence: Emerging use of technology, Current Opinions in Cardiology, 26(4), doi: 10.1097/HCO.0b013e328347c150

Lee, J., Nguyen, A. L., Berg, J., Amin, A., Bachman, M., Guo, Y., & Evangelista, L. (2014). Attitudes and preferences on the use of mobile health technology and health games for self-management: Interviews with older adults on anticoagulation therapy, JMIR Mhealth Uhealth, 2(3):e32, doi: 10.2196/mhealth.3196