Introduction

​Angiography is typically performed using the femoral arterial approach. Following the procedure, bed rest of 4 hours is recommended to prevent bleeding from the puncture site. 
Extended strict bed rest in the recovery unit can cause discomfort, back pain and increased medical costs.
 
Early ambulation is defined as gradual ambulation after or within two hours after sheath removal.

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Candidates

Candidates: The interventionalist identifies low-risk patients who may benefit from early ambulation and home discharge. The discharge plan is communicated to the NP and documented in Powerchart post-angiography orders. Some of these patients may need to be cleared for discharge by the anesthesiologis

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Poor Candidates

Poor candidates for early ambulation:

1. Difficult femoral access and prolonged time for hemostasisEarly complications such as hematoma at the time of sheath removal
2. Following cerebral interventions in patients requiring reduced stress or mobilization. 
3. Systemic diseases (such as hypertension)
4. Coagulopathy or anticoagulation.
5. Inability to understand or follow orders: Neonates, infants, developmental delay. 
6. History of prior delayed post-angiography bleeding.
7. Multiple and large vascular accesses (> 6 French).
8. Previous surgery to the iliac or femoral arteries

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References

- Pollard SD, Munks K, Wales C, Crossman DC, Cumberland DC, Oakley GD, Gunn J; Position and Mobilisation Post-Angiography Study. Heart. 2003 Apr;89(4):447-8.
 
-Rosenstein G, Cafri C, Weinstein JM, Yeroslavtsev S, Abuful A, Ilia R, Fuchs S. Simple clinical risk stratification and the safety of ambulation two hours after 6 French diagnostic heart catheterization. J Invasive Cardiol. 2004 Mar;16(3):126-8.
 
-Wendy Vlasic, Evid Based Nurs, 2004. An evidence-based approach to reducing bed rest in the invasive cardiology patient population. J Caring Sci. 2015 Jun 1;4(2):125-34. 2015.
 
-Abdollahi AA1, Mehranfard S2, Behnampour N3, Kordnejad AM. Effect of Positioning and Early Ambulation on Coronary Angiography Complications: a Randomized Clinical Trial.
 
-Walker S, Jen C, McCosker F, Cleary S. Comparison of complications in percutaneous coronary intervention patients mobilized at 3, 4, and 6 hours after femoral arterial sheath removal. J Cardiovasc Nurs. 2008 Sep-Oct;23(5):407-13.