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The Development of a Large Haematoma on Groin Site

The actual nursing concerns for this patient are:

  1. The development of a large haematoma on his groin site
  2. The leakage of blood from his groin site
  3. Increased chances of Infection
  4. Swelling and Acute pain

The potential nursing concerns for this patient are:

  1. Arteriovenous fistula
  2. Neuritis
  3. Pseudoaneurysm
  4. Vessel thrombosis

The Development of a Large Haematoma on Groin Site:

The major nursing concern is the development of a large groin haematoma after the angiogram, angioplasty, and stent to the Left Anterior Descending Artery. This procedure was completed via the Right femoral artery of the patient. Groin haematoma is a very common problem that usually happens to the patient if the femoral artery cannot be controlled after sheath removal (DeBruce, 2015). According to a study conducted by Wasana and Kingkarn, the development of groin haematoma is affected by post-cardiac catheterization care in hospitals (Wasana & Kingkarn, 2021). There are many factors that cause groin haematoma after angiogram and angioplasty. Some of the factors causing haematoma include age above 65 years, obesity, and the utilisation of several medications like clopidogrel, aspirin, and glycoprotein IIb/IIIa inhibitors (Themes, 2016).

The Leakage of Blood from the Groin Site:

Another nursing concern is the bleeding from the groin site of the patient. This bleeding may have occurred in the femoral sheath that consists of the femoral artery, femoral vein, and lymphatics ("Complications of Post Angioplasty Bleeding", 2020). This bleeding can be spread to the wall of the abdomen following the sheath wall. This bleeding can be dangerous and lead to other complications like multiorgan dysfunction if not diagnosed on time ("Complications of Post Angioplasty Bleeding", 2020). The leakage of blood from the groin site is also considered to be affected by several factors including hypertension history, diabetes mellitus, renal failure, and peripheral vascular disease (AL-Momani & AbuRuz, 2019). The patient’s history shows he had hypertension and Type 2 diabetes. Hence, these risk factors have increased the groin complications of this patient.

Increased Chances of Infection:

As the patient had gone through the angiogram and angioplasty, he already had reduced immunity. Because of his certain conditions like hypertension, age, diabetes, and cardiovascular complications, the risk of getting other infections may also increase after the development of a large haematoma and bleeding from his groin site. A wet bed is also a concern for nursing care as it may lead to the development of other infections. To stop the spread of any infection, it is important to understand the location of the haematoma. A CT scan can be helpful in getting an accurate assessment of the size and location of a haematoma (Brilakis, 2021). To learn about the presence of other complications, an ultrasound can also be utilised (Brilakis, 2021).

Swelling and Acute Pain:

When external bleeding accumulates or hides inside a tissue, it can form a haematoma. Haematoma varies in size; it can be small or large and leads to recognisable swelling. Due to the enhanced pressure on the blood vessels, the leakage of blood can be seen. This blood leakage is very frustrating and may result in other inflammatory symptoms such as swelling, pain, and redness (Yuliastuti & Rinarto, 2018). This is one of the major nursing concerns to assess the level of pain and swelling caused due to the groin haematoma to assist the patient accordingly.

The Leakage of Blood from the Groin Site

Arteriovenous Fistula:

The groin haematoma may also lead to arteriovenous fistula if cannot be managed immediately. An arteriovenous fistula is one of the key potential nursing concerns that results in the flow of blood from an artery into a vein by surpassing certain capillaries. In normal circumstances, the flow of blood originates from the artery to the capillaries and finally onto veins. Due to this condition, several tissues of the patient may receive less blood as they might be located below the bypassed capillaries. The treatment of this condition must be taken care of immediately as it can lead to other serious complications. There are certain risk factors that lead to this condition including cardiac catheterisation, medications like anticoagulants and ant-fibrinolytic, high blood pressure, high BMI, and older age ("Arteriovenous fistula - Symptoms and causes", 2020). Mr. Little also have some of these risk factors and hence, it is important to manage the bleeding and groin haematoma.

Neuritis:

Groin haematoma, bleeding, and longer stay on a wet bed may lead to infection and that might result in neuritis, which is defined as the inflammation of nerves. Mostly, this condition can be caused due to infection, injury, or autoimmune disease ("neuritis | pathology", 2022). In this case, neuritis can be caused due to the infection. The major symptoms of this condition are tenderness, pain, impaired sensation, impaired strength and reflexes, hypersensitivity, abnormality in circulation, and reduced sweat ability. Due to this condition, one or more than one nerves can be inflamed. The symptoms of this condition are mostly restricted to one specific area of the body aided by the inflamed nerves ("neuritis | pathology", 2022).  

Pseudoaneurysm:

As there was a leakage of blood from the groin site of the patient, there is a possibility of a potential nursing concern, which is pseudoaneurysm. This condition is caused due to an injury in the blood vessel. This injured blood vessel may lead to the collection of leaking blood in the tissue surrounding that area (Lopez-Jimenez, 2020). This type of condition is sometimes known as a false aneurysm. Another type of pseudoaneurysm is a true aneurysm, which shows the weakening and bulging of the artery or vessel that sometimes forms a sac filled with blood (Lopez-Jimenez, 2020). As per some studies, this condition is one of the major complications caused by cardiac catheterisation. Usually, pseudoaneurysm can be caused when there is a leakage of blood like in the case of Mr. Little. Due to the accumulation of blood outside the artery where there was the insertion of the catheter, this condition can be triggered (Lopez-Jimenez, 2020).

Vessel Thrombosis:

Another potential nursing concern is vessel thrombosis. This is a serious health condition in which there is the formation of one or more than one clots within the blood vessels. Because of this health condition, the blood flow can be blocked inside the blood vessels due to the formation of blood clots ("Thrombosis: Types, Causes, Symptoms & Treatment", 2022). These clots can move anywhere in the body and they can be stuck in dangerous locations like the brain or lungs. This condition can be life-threatening. This condition can occur to people of any age who have certain conditions like Atrial fibrillation, Cancer, Diabetes, or heart disease ("Thrombosis: Types, Causes, Symptoms & Treatment", 2022). The patient has most of the health complications that can affect this health condition.

Increased Chances of Infection

Assessment:

Assessing the full body is one of the most important post-operative initial interventions. It's significant to get a detailed medical history and do an in-depth physical examination as well to confirm that there are no medical complications that could result in additional upheavals (Acquadro et al., 2018). A thorough and systematic cardiovascular assessment is needed. It is important to check all vital signs immediately such as respiratory rate, temperature, oxygen saturation, pulse rate, systolic blood pressure, and level of consciousness, and record them appropriately based on current guidelines (Contributor, 2013). The assessment of the location and size of haematoma is necessary to get an understanding of the condition (DeBruce, 2015). The puncture site also needs to be assessed to get an understanding of bleeding, swelling, pain, and redness of haematoma ("Clinical Guidelines (Nursing): Care of the patient post-cardiac catheterisation", 2022).

Bleeding Management:

The management of bleeding via haematoma on the groin site is primarily important. To manage bleeding, an application of manual compression must be done over the haematoma ("Clinical Guidelines (Nursing): Care of the patient post cardiac catheterisation", 2022). This manual compression must be followed by a pressure dressing. To apply pressure above the puncture site, the patient must be lying supine and the limb must be elevated ("Clinical Guidelines (Nursing): Care of the patient post cardiac catheterisation", 2022). A heparin infusion must be stopped if the patient has a heparin infusion. Additionally, the pressure bandage must be reinforced. The physician must be informed immediately ("Clinical Guidelines (Nursing): Care of the patient post cardiac catheterisation", 2022).

Pain Management:

Pain remains a fundamental involvement during and after any surgical procedure. Sometimes, the pain is awful post-surgery. The perfect approach to managing pain is to determine the intensity of the pain & prepare in advance for it (Park & Park, 2019). Groin haematoma and bleeding are usually associated with pain, swelling, and redness that require immediate management (Yuliastuti & Rinarto, 2018). Considering Mr. Little’s large haematoma and bleeding, the assessment and management of pain are mandatory. The motive is to minimise side effects while decreasing or eradicating both pain and discomfort (Laigaard et al., 2021). The primary step is to analyse the severity, strength, and effects that increase pain. Bearing in mind the patient’s medical history, both pharmacologic and nonpharmacological parts of pain management such as pain-relieving drugs as well as education and comfort therapy ought to be used (Laigaard et al., 2021).  

Encourage Bed Rest:

Patients must be encouraged to get bed rest as long as possible (Health Times, 2022). He must lie flat for certain hours after the bleeding management and pain management. The bed can be tilted to a maximum of thirty degrees (Health Times, 2022). The patient can have his meals just after the management of haematoma and bleeding if he wishes. He may get out of bed when the specified time for bed rest is completed (Health Times, 2022). It is important for the safety of the patient that he must be assisted by a nurse for the first time he gets up. Also, the nurse must assess the blood pressure of the patient while laying down, sitting, and standing (Health Times, 2022).

Swelling and Acute Pain

Assessment:

This is a schedule, concept, evidence-based module, as well as a preliminary fact that supports recognising, classifying, and treating patients’ difficulties, complications as well as consequences in order to recover wellbeing (Song et al., 2019). When the assessment is selected as an intervention, it contributes to recognising fluctuations in the health status of the patient and constrains them from deteriorating. It is important for Mr. Little to assess his vital so that other complications cannot associate with haematoma.

Bleeding Management:

The primary reason for trauma-associated mortality around the world is internal bleeding. It can cause organ failure, coma, external bleeding, and eventually death if remain untreated (Huizen, 2017). The management of bleeding is necessary to reduce the worsening of the condition and a cold compress is perfect for this condition as it decreases the flow of blood to the puncture site (Plan, 2015). The use of manual compression also limits swelling and inflammation in the part of the haematoma. Stopping heparin infusion is also needed to stop severe bleeding (Plan, 2015).

Pain Management:

The management of pain is required to reduce the discomfort of the patient. An increase in pain can be a sign of increasing adversity of groin haematoma (Yuliastuti & Rinarto, 2018). Hence, it is important to understand the level and intensity of the pain and start medications and proper care accordingly.

Encourage Bed Rest:

Encouraging bed rest can provide improvement in blood circulation and reduce the hazard of further complications that could enhance the chance of the formation of a clot. The assessment of blood pressure is needed to understand any deterioration in health after standing. It will also help to initiate the management of the complication if required (Health Times, 2022).

References

Acquadro, C., Patrick, D. L., Eremenco, S., Martin, M. L., Kuli?, D., Correia, H., & Conway, K. (2018). Emerging good practices for translatability assessment (TA) of patient-reported outcome (PRO) measures. Journal of patient-reported outcomes, 2(1), 1-11.


AL-Momani, M., & AbuRuz, M. (2019). Incidence and predictors of groin complications early after coronary artery intervention: a prospective observational study. BMC Nursing, 18(1). doi: 10.1186/s12912-019-0349-8


Arteriovenous fistula - Symptoms and causes. (2020). Retrieved 22 April 2022, from

https://www.mayoclinic.org/diseases-conditions/arteriovenous-fistula/symptoms-causes/syc-20369567


Brilakis, E. (2021). Vascular access complications. Manual Of Percutaneous Coronary Interventions.


Clinical Guidelines (Nursing) : Care of the patient post cardiac catheterisation. (2022). Retrieved 24 April 2022, from https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Care_of_the_patien


Complications of Post Angioplasty Bleeding. (2020). Retrieved 22 April 2022, from https://nursinganswers.net/essays/complications-post-angioplasty-3628.php


Contributor, N. (2013). Postoperative care 1: principles of monitoring postoperative patients | Nursing Times. Retrieved 24 April 2022, from https://www.nursingtimes.net/clinical-archive/critical-care/postoperative-care-1-principles-of-monitoring-postoperative-patients-31-05-2013/


DeBruce, C. (2015). Post Procedure Groin Complications: An Overview of Clinical Responsibility, Documentation, and Legal Considerations. Retrieved 22 April 2022, from https://www.hmpgloballearningnetwork.com/site/cathlab/article/post-procedure-groin-complications-overview-clinical-responsibility-documentation-legal


Health Times. (2022). Caring for patients post cardiac catheterisation. Retrieved 24 April 2022, from https://healthtimes.com.au/hub/catheterisation/18/guidance/nc1/caring-for-patients-post-cardiac-catheterisation/1921/#:~:text=Patients%20should%20be%20kept%20lying,bed%20re


Huizen, J. (2017). Internal bleeding: Symptoms, treatment, and complications. Medicalnewstoday.com. Retrieved 24 April 2022, from https://www.medicalnewstoday.com/articles/320322.


Laigaard, J., Pedersen, C., Rønsbo, T. N., Mathiesen, O., & Karlsen, A. P. H. (2021). Minimal clinically important differences in randomised clinical trials on pain management after total hip and knee arthroplasty: a systematic review. British Journal of Anaesthesia, 126(5), 1029-1037.


Lopez-Jimenez, F. (2020). Pseudoaneurysm: What causes it?. Retrieved 23 April 2022, from https://www.mayoclinic.org/tests-procedures/cardiac-catheterization/expert-answers/pseudoaneurysm/faq-20058420#:~:text=A%20pseudoaneurysm%2C%20or%20pseudoaneurysm%20of,forming%20a%20blood%2Dfilled%20sac.

neuritis | pathology. (2022). Retrieved 23 April 2022, from https://www.britannica.com/science/neuritis


Park, C. S., & Park, E. J. (2019). Identification of knowledge structure of pain management nursing research applying text network analysis. Journal of Korean Academy of Nursing, 49(5), 538-549.


Plan, B. (2015). Nursing Interventions For Bruising | Bruises Care Plan | Planning for Care. Retrieved 24 April 2022, from https://www.planningforcare.co.uk/product/nursing-interventions-for-bruising/


Song, C., Cao, J., Zhang, F., Wang, C., Guo, Z., Lin, Y., ... & Shi, H. (2019). Nutritional risk assessment by scored patient-generated subjective global assessment associated with demographic characteristics in 23,904 common malignant tumors patients. Nutrition and cancer, 71(1), 50-60.


Themes, U. (2016). Local Complications. Retrieved 22 April 2022, from https://thoracickey.com/local-complications-7/


Thrombosis: Types, Causes, Symptoms & Treatment. (2022). Retrieved 24 April 2022, from https://my.clevelandclinic.org/health/diseases/22242-thrombosis


Wasana, L., & Kingkarn, K. (2021). Relationships of factors related to post cardiac catheterization groin hematoma among patients in cardiac care unit. Journal Of Nursing Science And Health, 44(1).


Yuliastuti, C., & Rinarto, N. (2018). The Nurses’ Compliance in Femoral Sheath Removal Procedure in Relation to the Incidence of Hematoma in Patients after PTCA. The 9Th International Nursing Conference: Nurses At The Forefront Transforming Care, Science And Research.

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