p ISSN 2723-6927-e ISSN 2723-4339
Comparison of Sand Pillows and Cold Compresses
in Reducing The Incidence of Hematoma in Post Percutaneous Coronary
Intervention (PCI) Patients: A Scoping Review
Qomaruddin Asy�ary1,
Titin Andri Wihastuti2, Dina Dewi Sartika Lestari Ismail3
1,2,3 Brawijaya University, Central Java, Indonesia
Email: [email protected]1,
[email protected]2, [email protected]3
ABSTRACT
Coronary heart disease is the most
common cause of morbidity and death in the world. Cardiac catheterization is
applied to diagnose and treat coronary heart disease. Non-invasive Percutaneous
Coronary Intervention (PCI) aims to open narrowed coronary blood vessels. The
most frequently used vascular installation site is the femoral artery. The PCI
procedure has several vascular complications, such as hematoma, which often
occur in post-PCI patients. Using sand pillows and cold compresses is one
measure to reduce the incidence of hematomas. This study aims to compare the
effectiveness of sand pillows and cold compresses in reducing hematomas in
post-PCI patients. This study was designed as a scoping review. Article
searches were limited to 2019-2024. Search using the Google Scholar,
ScienceDirect, and Proquest databases and using advanced search with the
keywords "sandbag," "cold pack," "hematoma," and
"percutaneous coronary intervention." A total of 45 articles were found,
and then by applying the specified inclusion criteria, we found 6 articles. The
6 articles obtained show that using a sand pillow can reduce the duration of
compression and speed up the achievement of hemostasis by pressing on the
arteries. Meanwhile, using cold compresses and cold packs can cause
vasoconstriction of blood vessels, speed up blood clotting time, and form blood
clots. It can be concluded that cold compresses are more effective in reducing
the incidence of hematomas in post-PCI patients compared to using sand pillows.
Keywords: cold pack,
hematoma, percutaneous coronary intervention, sandbag
INTRODUCTION
Acute coronary syndrome (ACS) is a cardiac emergency that causes high mortality rates in hospitals. Compared to other causes, acute coronary syndrome is the cause of most cardiac arrest events, with a survival rate of < 10% (Wihastuti et al., 2020). According to WHO, in 2015, there were 17.5 million deaths out of all global deaths caused by cardiovascular disease and 7.4 million deaths caused by acute coronary syndrome (Goodwill et al., 2019). Cardiac catheterization is used to perform early detection and establish the presence of coronary heart disease (Syahri & Andriani, 2021). Cardiac catheterization is also defined as an action or procedure using a catheter tube to evaluate the narrowing of the coronary blood vessels of the heart (Cauley et al., 2019).
Cardiac catheterization is divided into two groups: coronary
angiography and Percutaneous Coronary Intervention (PCI). PCI
aims to open the narrowing of the coronary blood vessels so that the blood
supply to the ischemic tissue increases (Cheema et al., 2020). However, as
with other interventional procedures, cardiac catheterization causes major and
minor complications. Major complications include myocardial infarction, stroke,
and death. Minor complications include transient ischemic attacks, arrhythmias,
vascular complications, allergic reactions related to contrast agents, and
renal failure. Among minor complications, vascular complications are more
common than others (Korkmaz1a & Karag�zoğlu, 2022). Artery Femoral is a
frequently used access to PCI measures. However, there are some complications
of femoral access, such as infection (0-1%), pseudoaneurysms and arteriovenous
fistulas (0.1-0.6%), and hematomas (0.5-1.7%) (Sari et al., 2017).
Hematoma
events are vascular complications that are frequent to PCI measures,
potentially leading to serious complications (Baidhowy et al., R, & Listiani, 2021). Hematomas can cause increased morbidity, where hematomas will prolong
the patient's bed rest period, and in general, patients will complain of leg
aches and cramps, pain in the thigh folds, and pain in the back of the waist (Manik, 2015). Hematoma occurs due to tearing after sheath removal and in the former
puncture area that is not completely closed (Abdelaal et al., 2015). Research conducted by (Cauley et al., 2019) states that hematomas have signs such as swelling, pain, or
neurovascular symptoms. This is because there is an accumulation of blood
outside the intravascular. This condition can occur if the walls of arteries,
veins, or capillaries are damaged so that blood exits into the tissue.
One of the nursing interventions used to reduce the incidence of hematomas
is the use of sand pillows and cold compresses (Kurt & Kaşık�ı, 2019;
Syahri & Andriani, 2021). Sand pillows can shorten the duration of compression and help achieve
hemostasis by applying pressure to the arteries to prevent hematomas (Manik, 2015). While cold compresses are applied using cold packtaste, pain is inhibited at cold
temperatures by decreasing the speed of impulses transmitted by nerve fibers. Vasoconstriction
in arteries and veins is caused by the influence of temperature that stimulates
smooth muscles in the lining of blood vessels. In addition, vasoconstriction also lowers bleeding and swelling in injured
tissue (Sari
et al., 2017).
Considering the importance of reducing the incidence of hematomas
in post-PCI patients by intervention using sand pillows and cold compresses,
researchers are therefore interested in conducting a literature review related
to the comparison of the application of sand pillows and cold compresses in
reducing the incidence of hematomas in post-PCI patients.
RESEARCH METHODS
The research method used in
this scoping review is a scoping review approach regarding the Arskey and
O'Malley framework. The stages in the preparation of the scoping review include
identifying research questions, identifying relevant literature sources, selecting
literature, mapping and collecting literature, compiling, summarizing, and
reporting the results of literature analysis, as well as consultation with
competent parties. Literature searches are conducted through Google Scholar, ScienceDirect,
and Proquest databases using advanced search and certain keywords such as
"sandbag," "cold pack," "hematoma," and
"percutaneous coronary intervention," with restrictions in 2019-2024.
Inclusion criteria in this
review include articles in Indonesian and English, original papers or review
literature, and full text. In contrast, exclusion criteria include books or
modules, theses, theses, dissertations, scientific papers, articles that are
issues for debate, letter editors, protocols, prereviews, and paid/inaccessible/non-full
text articles. Articles that meet the inclusion criteria are then identified,
filtered, extracted, and displayed in a table containing information about the
title, author, year of publication, country of research location, research
objectives, research design, and research conclusions. The data extraction
results are then analyzed and elaborated in more detail in the discussion.
The research process
involves screening articles based on title, abstract, year of publication, and
age after removing duplicates, as well as assessing the eligibility of articles
based on inclusion and exclusion criteria. The entire study was consulted with
other authors for validation. The data were then mapped into tables to
summarize the narrative findings of the results of this exploratory review,
including study characteristics, hematoma incidence, hematoma risk factors, and
the application of cold compresses to reduce hematomas. Information on the
effect of the successful application of cold compresses is taken from the
discussion and presented in table format in Microsoft Word 2016.
RESULTS AND DISCUSSIONS
Characteristics of the selected studies
After a literature search
according to the inclusion and exclusion criteria, One article
with experimental research design methods, a randomized posttest-only Control
Groupon article with Design Experiment Methods
control group, and four articles with methods Randomized Control (RCT). Based on the 6 articles found, Scoping
Review This indicates that the application of a cold compress or cold
pack in post-PCI patients is more effective in reducing the incidence of
hematomas compared to the use of sand pillows ((Ebrahimi-Shalmani et al., 2020);(Kareem & Al-Kassar, 2023);(Korkmaz1a & Karag�zoğlu, 2022);(Korkmaz1a & Karag�zoğlu, 2022);(Valikhani et al., 2020);(Syahri & Andriani, 2021)).
Percutaneous Coronary Intervention (PCI)
Percutaneous Coronary Intervention (PCI) is a non-surgical
invasive procedure or procedure performed on patients with coronary heart
disease to open occlusion or narrow the coronary arteries and increase blood
supply to the systemic (Ahmad et al., 2020). PCI is done
by dilating narrowed arteries and patenting them by installing stents to keep
them open (Nuraeni et al., 2023). PCI is the
primary treatment in patients with ST-elevation myocardial infarction (STEMI) (Mole et al., 2016). PCI
procedure has several vascular complications that can occur, such as infection,
arterial fistula, retroperitoneal hemorrhage, pseudoaneurysm, and hematoma (Khoiriyati et al., 2013).
Hematoma
Hematoma is a vascular complication often occurring after PCI (Abdelaal et al., 2015). Research
conducted by (Cauley et al., 2019) states that
the hematoma has signs such as swelling, pain, or neurovascular symptoms. This
is due to the accumulation of blood outside the intravascular. This condition
can occur when the walls of arteries, veins, or capillaries are damaged so that
blood exits into the tissues. Some studies reported minor bleeding due to
catheter removal in the femoral artery area (Kurt & Kaşık�ı, 2019). Previous
studies have also suggested that post-PCI bleeding and hematoma complications
can increase the length of stay and increase the cost of hospitalization (Numasawa et al., 2017). Decreased
capillary permeability and increased blood clotting and metabolic needs cause
bleeding to be controlled and prevent hematomas (Kurt & Kaşık�ı, 2019).
Discussion
Application
of sand pillows and cold compresses
Effective non-pharmacological interventions in post-PCI patients To reduce the occurrence of hematomas, cold compresses are applied.
The intervention aims to make the patient feel comfortable, and pain can be
minimized (Baidhowy et al., 2021). In
addition, using sand pillows is also an intervention that can reduce the
occurrence of hematomas (Syahri & Andriani, 2021). (Swami et al., 2024) conducted a
randomized controlled trial on 50 patients to identify the optimal method of
lowering hematomas. One group was treated with a sand pillow weighing 2 kg,
while the other group used a cold compress with an Ice pack weighing 365 grams
to achieve hemostasis in the femoral area after removing the sheath. The sand
pillow group was the control while the ice pack group was the intervention
group. Hematomas occurred in both groups at 30-minute intervals over 3-hour
intervals. The results stated a significant difference in the rate of hematoma
reduction between the two groups. Namely, hematoma decreased significantly in
the intervention group with cold compresses using ice packs compared to the sand
pillows group (Valikhani et al., 2020).
Several other studies have also compared the use of sand pillows
with the use of cold packs (Kurt & Kaşık�ı, 2019; Pamuk &
�zkaraman, 2024; Syahri & Andriani, 2021). Literature
studies conducted by Baidhowy et al. (2021) explained
that using sand pillows is a less effective intervention. Sand pillows are
placed on the patient's upper femoral area in bed for long periods, causing the patient to be disturbed and in pain (Korkmaz1a & Karag�zoğlu, 2022). Another
study also found that the group using sand pillows had hematomas by 18% and
bleeding by 8% (��r�k, 2017). However,
research (Sari et al., 2017) stated no significant difference in hematoma development
within 24 hours in post-PCI patients who used sand pillows or cold compresses.
However, using sand pillows causes tingling, pain, and difficulty moving in the
access area after sheath removal.
Although statistically not statistically significantly associated
with hematomas, the application of cold compresses found lower hematomas than
other groups (Korkmaz1a & Karag�zoğlu, 2022). This happens because the
application of cold compresses a decrease in blood flow, increased coagulation,
increased viscosity, and decreased metabolic density so that bleeding can be
controlled in accordance with the research (Ginanjar et al., 2018), where
experiments with the application of cold compresses and early ambulation with a
control group using sand pillows and the results showed that the application of
cold compresses with early ambulation was more effective than sand pillows in
reducing the incidence of hematomas.
Several studies have shown that the application of cold compresses
is effective in reducing hematomas in post-PCI patients ((Ebrahimi-Shalmani et al., 2020);(Kareem & Al-Kassar, 2023);(Valikhani et al., 2020);(Syahri & Andriani, 2021)). In addition, cold compresses also have the effect of
vasoconstricting blood vessels, accelerating blood clotting time, and blood
clot formation (Senan et al., 2020). Cold
compresses are a nonpharmacological method that enhances the coagulation
process by causing vasoconstriction, which leads to decreased blood flow and
increased blood viscosity. Thus, increased coagulation and decreased capillary
permeability, as well as metabolic needs, facilitate the control of bleeding at
the site of trauma. Therefore, the application of cold compresses for femoral
sheath removal in post-PCI patients can reduce the occurrence of hematomas,
hemorrhages, and ecchymoses (Baidhowy et al., 2021; Kareem & Al-Kassar, 2023). In addition,
cold compresses also have an effect on the nerves, which decreases the release
of local pain mediators and slows peripheral nerve conduction (Ginanjar et al., 2018).
According to (Kurt & Kaşık�ı, 2019), the
application of cold compresses reduces the formation of hematomas in the
femoral artery area after catheter withdrawal, and the size of the growing
hematoma is small. The low grade and small size of hematomas in the
experimental group are considered to be the result of the application of cold
compresses. One of the physiological effects is to reduce the speed of blood flow
and increase its viscosity. In line with (Kareem & Al-Kassar, 2023), Yang
explains that cold compress therapy has long been used as a noninvasive method
to control bleeding. The physiological effects of cold compress therapy include
arterial contractions, which ultimately result in decreased peripheral blood
circulation, histamine release, inflammation, muscle spasms, and successive
nerve conduction speeds. Slows blood flow by increasing the viscosity of blood
flow to an invasively administered bleeding site; ice packs (cold packs) can
also facilitate better achievement of hemostasis and fewer vascular
complications such as hematomas.
Research conducted (Pamuk & �zkaraman, 2024) It is also stated that the
use of cold compresses, along with sand pillows, is also effective in
preventing perivascular complications. Cold compresses control bleeding by
reducing capillary blood flow and capillary permeability through arteriole
vasoconstriction. In addition, it reduces the blood flow rate and increases
viscosity, thereby providing coagulation. Cold compresses reduce the
development of ecchymosis and hematomas.�
In addition, cold compresses are preferred to prevent and treat vascular
complications because they are more practical and inexpensive, can increase
patient comfort, reduce pain, and significantly reduce hematomas in the
intervention area.
The
Role of Nurses in Hematoma Management
Seeing a positive impact on the use of cold compresses in post-PCI
patients compared to the use of sand pillows that can cause pain in patients.
Where pain can negatively affect the healing process by causing anxiety and
fatigue in patients, so the use of cold compresses becomes a more effective
method in reducing the occurrence of hematomas. Therefore, nurses have an
important role in preventing hematomas, and the key is early recognition and
prevention of complications (Kurt & Kaşık�ı, 2019; Nuraeni et
al., 2023). Controlling
vascular complications such as hematomas can reduce the length of
hospitalization and medical costs of patients. Prevention of complications is
also important to provide collaboration and adherence to the process, thus
speeding up the recovery process. This can increase the level of patient
satisfaction and the quality of nursing services better (��r�k, 2017).
CONCLUSION
Based on the results of the
scoping review, it can be recommended that the application of cold compresses
is more effective in reducing the incidence of hematomas, so it can be an
option for performing mechanical suppression to prevent bleeding in post-PCI
patients. While
the scoping review suggests the superiority of cold compresses in reducing
hematoma incidence post-PCI, certain confounding factors warrant further
investigation. The recommendation lacks granularity concerning these
confounders, emphasizing the necessity for more comprehensive research.
Additionally, a more exhaustive summary of the evidence supporting the
recommendation is required to bolster its validity. Nonetheless, nurses play a
pivotal role in preventing vascular complications post-cardiac catheterization,
facilitating patient collaboration and adherence to recovery processes, and ultimately
enhancing patient satisfaction with nursing services. Future research endeavors
should meticulously address these confounders to provide new insights and
optimize the quality of nursing care in post-PCI patients.��
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Copyright Holder: Qomaruddin Asy�ary1, Titin Andri
Wihastuti2, Dina Dewi Sartika Lestari Ismail3 (2024) |
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First Publication Right: Journal of Health Science |
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