Effect of External Compression Bandage on Forearm Swelling, Discomfort, and Pain Following the Removal of a Radial Artery Conduit for CABGS

Abstract

PURPOSE: Studies highlight the effectiveness of the radial artery (RA) as a conduit for CABGS however scant evidence describing management of the harvest site in the postoperative context exists. The purpose of this study was to determine whether a compression dressing effectively reduces forearm swelling, discomfort and pain in order to identify the optimal dressing choice for RA harvest site. METHODS: A prospective randomized trial was conducted to compare the effectiveness of three dressings. All harvest sites were dressed with Primapore and a crepe bandage (CB) in theatre. Group 1 controls received standard care (removal of CB 24 hours after surgery), Groups 2 and 3 had Tubigrip to wrist or first knuckles respectively following removal of CB. Patients were recruited preoperatively and randomised to treatment group if a RA conduit was harvested in the ICU by an investigator not involved in patient care. Opaque envelopes concealed dressing protocols until time of randomization. Forearm measures (circumference 60mm from elbow crease, 40 mm from wrist and halfway between these points) were recorded preoperatively, once randomization had occurred and 72 hours after surgery. RESULTS: From January 2008 to December 2009 175 participants were recruited; 49 (28%) in the control group, 68 (38.9%) in the Tubigrip to wrist and 58 (33.1%) in the Tubigrip to knuckles groups respectively. Patients had an average of 3 (SD 0.9, Min 1, Max 7) distal conduits, 2.6 (SD 0.9) arterial. RA conduits provided on average 1.3 (SD 0.5) distal anastamoses. There were no between group differences in demographic or operative characteristics including number of radial grafts or distal anastamoses. There was no evidence to suggest differences between groups in terms of dressing awareness, comfort with rest or activity, pain at dressing site or patient satisfaction. Greatest reduction in swelling was evident in the Tubigrip to knuckles group (p 0.021) at the forearm and wrist (p 0.053) on postoperative day three. CONCLUSIONS: Tubigrip to knuckles is the optimal dressing choice for RA harvest site. CLINICAL IMPLICATIONS: Additional research investigating dressing selection choices for RA harvest sites is required.