Early ambulation after diagnostic transfemoral catheterisation: a systematic review and meta-analysis.

BACKGROUND Femoral arterial puncture is the most common method of vascular access for angiography. Because of possible vascular events, all patients are restricted to strict immobilisation and bed rest for 2-24h, which is accompanied by back pain and discomfort. OBJECTIVE To assess the effects of the duration of bed rest after transfemoral catheterisation on the prevention of vascular complications and general discomfort, pain, urinary discomfort and patient satisfaction. DATA SOURCES We searched the Cochrane Library, MEDLINE, SCOPUS, CINAHL, Proquest Dissertations, Open SIGLE, Iranmedex and Irandoc. STUDY SELECTION We included blinded or unblinded randomised controlled trials and quasi-randomised controlled trials that used two different durations of bed rest after angiography before the ambulation was permitted. DATA EXTRACTION AND ANALYSIS Two reviewers separately assessed the quality of each study and extracted the data. We present dichotomous outcomes as odds ratios with 95% confidence intervals (CI) and continuous outcomes as mean differences with 95% CI. DATA SYNTHESIS Twenty studies involving a total of 4019 participants with a mean age of 59.5 years were included. The studies considered periods of bed rest ranging from 2 to 24h, which we compared in three main categories. There were no statistically significant differences between categories in the incidence of bleeding, haematoma, bruising, pseudoaneurysm, thrombus or arteriovenous fistula. Back pain intensity was assessed in four studies. Patients had significantly less back pain after 2-4h bed rest compared to 6h bed rest at 2h (mean difference: -0.70, 95% CI: -1.07, -0.32), 4h (mean difference: -0.60, 95% CI: -0.96, -0.24) and 6h of follow-up (mean difference: -3.77, 95% CI: -4.48, -2.92). One study that assessed urinary discomfort reported less urinary discomfort when bed rest lasted 4h compared to 12-24h (mean difference: -1.48; 95% CI: -2.37, -0.59). In addition, reduced bed rest time may significantly decrease the costs of hospital care. CONCLUSIONS This systematic review suggests that patients can be ambulated after 2-3h following transfemoral catheterisation, and that early ambulation had no significant effect on the incidence of vascular complications and may reduce back pain and urinary discomfort.