1. Angie O’Plasty Casey Jernigan Caroline Stovall Amanda Pitts

2. The Case 50 Year Old African American Female Diabetes Mellitus HTN Heavy Smoker 5’1” 200lbs Sedentary lifestyle Family history of heart problems

3. The Case: Symptoms Unusual epigastric pain Nausea Diaphoretic Neck pain Stress

4. The Case: Doctors Orders EKG Cardiac panel Chest X-ray Urinalysis Standard chemistry CBC Troponins Creatinine protein

5. The Case: Diagnoses Elevated Troponins Elevated ST segment on EKG Diagnosed with an acute myocardial infarction (MI) The physician ordered a cardiology consult and a cardiac catheterization A double angioplasty was performed A femoral artery access site was closure was performed with Perclose

6. Manual Compression

7. Perclose http://www.youtube.com/watch?v=NMWzXcUZfxA

8. 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?

9. Targeted Resources COCHRAN PubMed Keywords: Perclose Other key words related to our case study were unsuccessful

10. PPAARE ComponentCase Example ProblemWas the closure method used the best method for closure of femoral artery following angioplasty? Patient50 year old, African American woman recovering from a double angioplasty following a myocardial infarction. ActionWatching and observing patient response to procedure and recovery time AlternativeNA Patient ResultsThat the closure method was the best to reduce risk factors, maintain patient comfort, encourage ambulation Level of EvidencePeer reviewed articles, controlled studies, and trustworthy organizations publications Targeted Resources

11. Relevant Evidence

14. Course of Action Monitor the patient for signs that the Perclose was ineffective Additional Monitoring due to patients risk factors include: Monitoring signs of infection Monitoring for the development of blood clots Monitoring 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.

15. Conclusion The 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.

16. References Al-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/UnderstandYourRiskforHighBlo odPressure/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