Theresia Febriana Christi Tyas Utami, Diyah Fatmasari, Mardiyono Mardiyono, Shobirun Shobirun

DOI: https://doi.org/10.33546/bnj.356


Background: Coronary angiography can cause complications of arterial and subcutaneous bleeding (hematoma) and back pain. Changing the position of the patient (positioning) in bed can reduce the pain post-diagnostic catheterization complications. 

Objective: This study was to examine the effect of positioning on bleeding complication and low back pain after diagnostic coronary angiography in patients with coronary heart disease patient in the Integrated Heart Care Center in Indonesia.

Methods: This study was a true-experimental study with randomized posttest-only control group design. Thirty respondents were randomly selected using simple random sampling, which 15 respondents were randomly assigned in the experiment group and control group. The experiment group was given a positioning with 150, 300, 450 head-of-bed elevation in left and right lateral position. An arc tool was used to measure the height of head of bed elevation, a measuring cup to measure arterial bleeding using, a perforated transparent plastic with 5 cm diameter to measure subcutaneous bleeding (hematoma), and Numeric Pain Rating Scale to measure low back pain. Data were analyzed using Kolmogorov- Smirnov and Repeated Measured ANOVA.

Results: Findings showed that positioning had no effect on arterial hemorrhage (ρ=1.000) and subcutaneous bleeding (hematoma) (ρ=0.999). Repeated ANOVA test results revealed that positioning had a significant effect on low back pain (ρ=0.017). 

Conclusion: There was no significant effect of positioning on the occurrence of arterial and subcutaneous bleeding (hematoma), but there was a significant effect in reducing low back pain.


positioning; arterial bleeding; subcutaneous bleeding; back pain

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Armendaris, M. K., Azzolin, K. d. O., Alves, F. J. M. S., Ritter, S. G., & Moraes, M. A. P. d. (2008). Incidence of vascular complications in patients submitted to percutaneous transluminal coronary angioplasty by transradial and transfemoral arterial approach. Acta Paulista de Enfermagem, 21(1), 107-111.

Bonow, R. O., Mann, D. L., Zipes, D. P., & Libby, P. (2011). Braunwald's heart disease e-book: A textbook of cardiovascular medicine. Philadelphia: Elsevier Health Sciences.

Chair, S. Y., Fernandez, R., Lui, M. H. L., Lopez, V., & Thompson, D. R. (2008). The clinical effectiveness of length of bed rest for patients recovering from trans‐femoral diagnostic cardiac catheterisation. International Journal of Evidence‐Based Healthcare, 6(4), 352-390.

Chair, S. Y., Taylor‐Piliae, R. E., Lam, G., & Chan, S. (2003). Effect of positioning on back pain after coronary angiography. Journal of Advanced Nursing, 42(5), 470-478.

Farmanbar, R., Mohammadiyan, M. A., Moghaddamniya, M. T., Kazemnejad, E., & Salari, A. (2012). The effect of position change and bed-rest duration after coronary angiography on vascular complications. IJCCN, 4, 177-182.

Guyton, A. C., & Hall, J. E. (2012). Sensasi somatik: Buku ajar fisiologi kedokteran [Somatic sensation: Teaching book of medicine physiology] (11th ed.). Jakarta: EGC.

Hata, J., & Kiyohara, Y. (2013). Epidemiology of stroke and coronary artery disease in Asia. Circulation Journal, 77(8), 1923-1932.

Heintzen, M. P., & Strauer, B. E. (1998). Local vascular complications after cardiac catheterization. Herz-Kardiovaskulare Erkrankungen, 23(1), 4-20.

Jones, T., & McCutcheon, H. (2002). Effectiveness of mechanical compression devices in attaining hemostasis after femoral sheath removal. American Journal of Critical Care, 11(2), 155-162.

Kozier, B. (2008). Fundamentals of nursing: concepts, process and practice. London: Pearson Education.

Kusumantoro, A. (2013). Pengaruh penggunaan bantal pasir terhadap keluhan ketidaknyamanan pasien pasca percutaneous coronary angiography (PCA) di instalasi jantung dan pembuluh darah RSUP dr. Kariadi Semarang [Effect of using sand cushions on complaints of patient discomfort after percutaneous coronary angiography (PCA) at Installation of hearth and blood vessel of RSUP dr. Kariadi Semarang]. FIKkeS, 6(1).

Lehmann, K. G., Ferris, S. T., & Heath-Lange, S. J. (1997). Maintenance of hemostasis after invasive cardiac procedures: Implications for outpatient catheterization. Journal of the American College of Cardiology, 30(2), 444-451.

Maharani, S. I., Pramono, N., & Wahyuni, S. (2017). Dark chocolate’s effect on menstrual pain in late adolescents. Belitung Nursing Journal, 3(6), 686-692.

Manik, M. J. (2015). Perbedaan bantal pasir dan cold-pack dalam mencegah komplikasi pasca kateterisasi jantung [Effect of sand cushions and cold-pack in preventing complication of post-chateterization of heart]. Jurnal Keperawatan Soedirman, 10(2), 105-113.

May, O., Schlosser, H., & Skytte, L. (2008). A randomized trial assessing the influence of lying still or being allowed to move in the observation period following coronary angiography using the femoral approach. Journal of Interventional Cardiology, 21(4), 347-349.

MOH. (2014). Heart health condition. Jakarta: Pusat Data dan Informasi, Ministry of Health, the Republic of Indonesia.

Olade, R. B. (2016). Cardiac catheterization of left heart. Retrieved 15 December, 2017, from https://emedicine.medscape.com/article/1819224-overview

Panggabean HA. (2011). Perbedaan pengaruh ambulasi dini 2 jam dengan ambulasi 8 jam terhadap kejadian perdarahan pada pasien pascaangiografi koroner diagnostik di RSUP. Haji Adam Malik Medan [Difference in the effect of 2-hour and 8-hour early ambulation on bleeding in patients of diagnostic coronary pascaangiography]. Medan: Fakultas Ilmu Keperawatan Universitas Indonesia.

Perry, A. G., & Potter, P. A. (2005). Buku ajar fundamental keperawatan: Konsep, proses, dan praktik [Teaching book of basic nursing: Concept, process, and practice]. Jakarta: EGC.

Pooler-Lunse, C., Barkman, A., & Bock, B. F. (1996). Effects of modified positioning and mobilization on back pain and delayed bleeding in patients who had received heparin and undergone angiography: A pilot study. Heart & Lung: The Journal of Acute and Critical Care, 25(2), 117-123.

Potter, P. A., & Perry, A. G. (2005). Buku ajar fundamental keperawatan: Konsep, proses, dan praktik [Teaching book of basic nursing: Concept, process, and practice]. Jakarta: EGC.

Reynolds, S., Waterhouse, K., & Miller, K. H. (2001). Head of bed elevation, early walking, and patient comfort after percutaneous transluminal coronary angioplasty. Dimensions of Critical Care Nursing, 20(3), 44-51.

Rezaei‐Adaryani, M., Ahmadi, F., Mohamadi, E., & Asghari‐Jafarabadi, M. (2009). The effect of three positioning methods on patient outcomes after cardiac catheterization. Journal of Advanced Nursing, 65(2), 417-424.

RSCM. (2013). Buku ajar keperawatan kardiologi dasar [Teaching book of basic cardiology]. Jakarta Indonesia: Rumah Sakit Cipto Mangunkusumo.

Sinaga, J., Nurachmah, E., & Gayatri, D. (2012). Penekanan bantal pasir efektif untuk klien paska kateterisasi jantung dengan komplikasi: Randomized controlled trial [Sand pillow suppression is effective for clients after cardiac chateterization with complication: Randomized controlled trial]. Jurnal Keperawatan Indonesia, 15(3), 171-178.

Vlasic, W. (2004). An evidence-based approach to reducing bed rest in the invasive cardiology patient population. Evidence-Based Nursing, 7(4), 100-101.

WHO. (2012). World health statistics. Geneva: World Health Organization.

Woods, S. L. (2010). Cardiac nursing. Philadelphia: Lippincott Williams & Wilkins.

Yilmaz, E., Gurgun, C., & Dramali, A. (2007). Minimizing short-term complications in patients who have undergone cardiac invasive procedure: a randomized controlled trial involving position change and sandbag [Kardiyak invazif girisim yapilan hastalarda kisa donem komplikasyonlari azaltma: kum torbasi ve pozisyon degisikligini iceren randomize kontrollu bir calisma]. The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi), 7(4), 390-397.


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