RESUMEN
Background: Though coronary artery bypass graft (CABG) is a life-saving surgery and a standardized procedure, the aim of the surgery is survival with quality of life (QOL). The extended role of the nurse was well recommended in community and clinical settings with the support of multidisciplinary team for safe care. The Extended Nursing Care Model (ENCM) provides the framework to facilitate early recovery and thereby improve the QOL and overall productivity after CABG. Aim and Objective: The aim of this article is to compare the difference in QOL of CABG patients with and without ENCM. Materials and Methods: Quasi-experimental Time Series Design with Comparison Group was used to study the effectiveness of ENCM. Among CABG patients enrolled on the day of admission with non-probability purposive sampling technique, 140 patients were randomly and equally distributed in the study and control groups on the day of discharge for recovery management. Generic EQ-5D-5L scale and MacNew Heart Disease-related QOL (MNHDRQOL) questionnaire were used to collect data at frequent intervals. The data obtained successfully from 69 patients in the study group and 63 patients in the control group were analyzed by using SPSS-21 Statistical Software, Mann–Whitney U-test, and Wilcoxon signed-rank test. Results: There was an improvement in the EQ-5D-5L score and MNHDRQOL score from baseline (before surgery) to 6th week and 12th week after surgery. This difference is statistically higher in the study group than in the control group (P <0.05) in all five domains of Euro QOL and all three domains of MNHDRQOL. Conclusion: Nursing care provided by using ENCM is effective in improving the QOL of CABG patients.
RESUMEN
Background: Ultrasound (US)-guided internal jugular vein (IJV) cannulation is a widely accepted standard procedure. The axillary vein (AV) in comparison to the subclavian vein is easily visualized, but its cannulation is not extensively studied in cardiac patients. Aims: This study is an attempt to study the efficacy of real-time US-guided axillary venous cannulation as a safe alternative for the time-tested US-guided IJV cannulation. Design: This is a prospective randomized controlled study. Materials and Methods: A total of 100 adult patients scheduled for cardiac surgery were divided equally in Group A-US-guided IJV cannulation, and Group B-US-guided axillary venous cannulation. Under local anesthesia and real-time US guidance the IJV or AV was secured. The access time, guidewire time, and procedure time were noted. Furthermore, the number of needle attempts, malposition, change of site, and complications were noted. Results: The data were analyzed for 49 patients in Group A and 48 patients in the Group B due to exclusions. The access time and the guidewire time were comparable in both groups. The first attempt needle puncture was successful for the IJV group in 98% of patients in comparison to 95% of patients in Group B. Guidewire was passed in the first attempt in 94% in Group A and 89% in the Group B. Except for arterial puncture in one case in group A, the complications were insignificant in both groups. Conclusion: The study shows that the US-guided AV cannulation may serve as an effective alternative to the IJV cannulation in cardiac surgery.