***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Cardiac catheterisation plays a vital role in the diagnosis and evaluation of cardiac conditions . The goal of management of patients after cardiac catheterisation  is to reduce the risk of development of any local or prolonged vascular complications , in particular bleeding and haematoma formation at the puncture site . Bed rest and immobilisation of the affected leg are recommended practice s to ensure adequate haemostasis at the femoral arterial puncture site and prevent complications . Objectives The objective of this review was to present the best available evidence for the optimal length of bed rest after trans‐femoral diagnostic cardiac catheterisation . The main outcome of interest was the incidence of bleeding and haematoma formation following varying periods of bed rest . Search strategy We search ed the following data bases : CINAHL , Medline , Cochrane Library , Current Contents , EBSCO , Web of Science , Embase , British Nursing Index , Controlled clinical trials data base , Google Scholar . Reference lists of relevant articles and conference proceedings were search ed . We also contacted key organisations and research ers in the field . Selection criteria All r and omised and quasi‐r and omised controlled trials that compared the effects of different lengths of bed rest following trans‐femoral diagnostic cardiac catheterisation on patient outcomes were considered for inclusion in the review . Data collection and analysis Eligibility of the trials for inclusion in the review , details of eligible trials and the method ological quality of the trials were assessed independently by two review ers . Odds ratios ( OR ) for dichotomous data and a weighted mean difference for continuous data were calculated with 95 % confidence intervals ( CI ) . Where synthesis was inappropriate , trials were considered separately . Main results Eighteen trials involving a total of 4294 participants were included in the review . One trial included three treatment groups . In seven trials among 747 people there was no significant difference in the incidence of bleeding following six or less than 6 h of bed rest ( OR 1.47 ; 95 % CI 0.60 , 3.64 ) . Likewise , there was no significant difference in the incidence of bleeding following bed rest at other time periods . In eight trials involving 2272 patients there was no significant difference in the incidence of haematoma formation following 6 or less than 6 h of bed rest ( OR 0.82 ; 95 % CI 0.59 , 1.16 ) . Significantly fewer patients r and omised to less than 6 h of bed rest complained of back pain . The odds of developing back pain at 4 ( OR 24.60 ; 95 % CI 1.29 , 469 ) and 24 h ( OR 2.47 ; 95 % CI 1.16 , 5.23 ) following coronary catheterisation was significantly higher among patients r and omised to 6 compared with 3 h of bed rest . Authors ' conclusions There is evidence of no benefit relating to bleeding and haematoma formation in patients who have more than 3 h of bed rest following trans‐femoral diagnostic cardiac catheterisation . However , there is evidence of benefit relating to decreased incidence and severity of back pain and cost‐effectiveness following 3 h of bed rest . There is suggestive but inconclusive evidence of a benefit from bed rest for 2 h following trans‐femoral cardiac catheterisation . Clinicians should consider a balance between avoiding increased risk of haematoma formation following 2‐2.5 h of bed rest and circumventing back pain following more than 4 h of bed rest In 2003 , the Honour Society of Nursing , Sigma Theta Tau International and Nursing Spectrum sponsored an “ Innovations in Clinical Excellence ” contest to recognise exemplars of evidence -based nursing practice . The following 5 papers are winning entries , which are published with permission of the Honour Society of Nursing , Sigma Theta Tau International . The most uncomfortable part of hospital admission for patients requiring coronary interventional and /or diagnostic procedures is the time required to lie flat after removal of the indwelling femoral arterial introducer sheath . Conventional practice required a minimum of 6 hours of supine bed rest after sheath removal , often result ing in the problem of back pain . The Nurse Practitioner/ Clinical Nurse Specialist ( NP/CNS ) for interventional cardiology targeted this problem for further investigation in 1994 and took the lead in determining the process and strategies to be used . A group of interested physicians and nurses was convened , reflecting the multidisciplinary interest in addressing this clinical problem . The basis for the practice of prolonged bed rest was a mix of ritual , research , and expert opinion . The expert consensus was that prolonged bed rest was required to ensure adequate haemostasis at the femoral arterial puncture site . Research , much of it conducted by nurse research ers , had been gradually demonstrating the safety of Background : Cardiac catheterization ( CC ) is a widely used cardiac investigation procedure in Hong Kong . However , back pain is frequently reported following CC due the prolonged bed rest after the procedure . Aim : The overall aim of this study was to examine factors associated with back pain  among Hong Kong Chinese patients after femoral access for CC .  Methods : A prospect i ve study , nested within a r and omized clinical trial ( RCT ) , employing secondary analysis of an existing data set from 419 Chinese adults receiving nonemergency CC  , were used . Following a review of literature , gender , age , history of back pain , type of dressing on the puncture site , length of bed rest duration , turning privilege during bed rest , catheter size used for CC , duration of the procedure , duration of hemostasis , and body weight were identified as potential factors affecting back pain level . Back pain was assessed at 6 h and the next morning after CC , using the Numeric Pain Intensity Scale ( NPIS ) . Analysis was done using multivariate analysis of variance ( MANOVA ) , after testing for normality of the distribution . Results : Turning privilege ( p=0.001 ) , age ( p=0.04 ) , and body weight ( p=0.006 ) were significantly related to level of back pain at 6 h and the next morning after CC . Conclusion : Results of this study may help nurses have a better underst and ing about patients ' physical needs and appropriate nursing interventions that can be planned to enhance patient comfort following CC BACKGROUND This study is the third in a series of investigations on the requisite length of time that patients should be restricted to bed after coronary arteriography or percutaneous transluminal coronary angioplasty using a femoral artery approach .  METHODS A prospect i ve , experimental-control group design with r and omization was used initially to compare the incidence of bleeding between patients who remained in bed for 4 hours and patients who remained in bed for 6 hours after sheath removal following percutaneous transluminal coronary angioplasty .  RESULTS Rapid changes in the healthcare environment led to nurses collecting complete data sets for the experimental group only . The experimental group ( n = 51 ) was 73 % male and 27 % female ; mean age was 57 years ( SD = 11.4 years ) .  Mean time in bed was 4.1 hours ( SD = 0.27 hours ) . Most patients ( 98 % ) did not bleed from the femoral artery access site after remaining in bed for 4 hours following sheath removal . Ninety-two percent of patients required analgesics while in bed . Mean length of stay after the angioplasty was 1.4 days ( SD = 0.79 days ) . Bleeding occurred in one subject and was related to multiple invasive procedures and an activated clotting time of greater than 200 seconds . CONCLUSIONS Requisite time in bed after percutaneous transluminal coronary angioplasty has been reduced to 4 hours at the University of Virginia Medical Center , the same time required for patients undergoing cardiac catheterization . Discomfort after the procedure remains to be addressed OBJECTIVES This study was performed to test the safety and efficacy of a novel bioabsorbable hemostatic puncture closure device deployed through an arterial sheath . BACKGROUND Cardiac catheterization procedures are associated with a risk of complications at the arterial access site . Increasing numbers of interventional procedures requiring large sheaths or intense anticoagulation underline the need for secure , rapid methods of obtaining hemostasis at the time of sheath removal . METHODS We conducted a r and omized , multicenter trial in 435 patients undergoing cardiac catheterization or angioplasty at eight participating centers . In 218 patients , hemostasis was achieved using the device ( group I ) ; 217 patients were assigned to the manual pressure control group ( group II ) . RESULTS There were no significant differences in baseline characteristics . Time to hemostasis was considerably shorter in group I ( 2.5 + /- 15.2 vs. 15.3 + /- 11.7 min [ mean + /- SD ] , p < 0.0001 ) . The deployment success rate for the device was 96 % , and 76 % of group I patients experienced immediate ( within 1 min ) hemostasis . Complication rates were lower in group I for bleeding , hematoma and occurrence of any complication . There was no difference in the small incidence of pseudoaneurysm formation . There was no change in either group in the ankle/brachial systolic blood pressure index . Ultrasound follow-up studies 60 days after device deployment revealed complete absorption of the device in all cases . Subgroup analysis revealed particular benefit in patients undergoing interventional procedures . The administration of heparin was associated with a significantly higher complication rate in the manual pressure control group , whereas heparin had no effect on hemostasis time or complication rates in the device group . CONCLUSIONS This sheath-deployed , bioabsorbable device provides a safe and effective means of obtaining rapid arterial hemostasis after cardiac catheterization procedures . It appears to be particularly useful in those patients most at risk for access site complications Outpatient cardiac catheterization is frequently performed , but the optimal recovery time after sheath removal has not been defined . Left heart catheterization was performed via the femoral artery utilizing 6 French catheters on 323 out patients . One hundred thirty-five patients were r and omized to ambulate at a mean of 2.5 hr ( group 1 ) after puncture site compression , whereas 188 patients were r and omized to ambulate at a mean of 4.1 hr ( group 2 ) . Telephone follow-up occurred within 48 hr . A small hematoma ( < 5 cm ) occurred in 2 ( 1.6 % ) patients in group 1 and in 4 ( 2.4 % ) patients in group 2 . These results indicate that it is safe to ambulate patients 2.5 hr following 6 French diagnostic heart catheterization BACKGROUND : During the last 3 decades , there were increasing tendency towards angioplasty because of its benefits . But , this procedure has its acute problems like bleeding and formation of hematoma in the removal place of the sheet . Based on research ers ’ clinical experiences , patients need a time of 8 - 12 hours for bed rest after coronary angioplasty . Recognizing desirable time for bed rest after angioplasty and remove the arterial sheet forms the foundation of related research es in the world . Getting out of bed soon after angioplasty , causes more comfortable feelings , less hospitalization period , fewer side effects of prolonged bed rest and less hospitalization expenses . Regarding less time for bed rest after angioplasty , the aim of this study was to assess the effect of the time of getting out of bed after angioplasty on the complications after removing the sheet in  coronary angioplasty patients . METHODS : This was an experimental clinical study conducted in one step and two groups . Sample s were included 124 angioplasty patients ( 62 in each group ) who were chosen r and omly from the CCU of Shahid Chamran hospital of the Isfahan University of Medical Sciences in 2007 . Data were gathered by observing and evaluating the patients , using a question naire and a checklist . After angioplasty , patients from the intervention group were taken out of bed in 4 hours and patients from the control group were taken out of bed in 8 hours . After taking out of bed , patients were examined for bleeding and formation of hematoma in the place of taking out the arterial sheet . Data were analyzed using descriptive and inferential statistics via SPSS software . RESULTS : Results showed no meaningful difference between the two groups after getting out of bed ( p > 0.05 ) regarding relative frequency of bleeding ( p = 0.50 ) , formation of hematoma ( p = 0.34 ) and average diameter of hematoma ( p = 0.39 ) . CONCLUSIONS : Results of this study showed that reducing the bed rest time to 4 hours after removing the arterial sheet of size 7 do not increase bleeding and formation of hematoma in the removal place of the sheet . So , those angioplasty  patients who do not have critical clinical condition and their vital symptoms are stabilized will be able to get out of bed 4 hours after removing the sheet AIM This paper is a report of a study to investigate the effect of three positioning protocol s on back pain , heart rate , blood pressure and vascular complications  after cardiac catheterization . BACKGROUND After cardiac catheterization , bed rest is prescribed in order to minimize vascular complications , but this often leads to back pain and other complications , such as hemodynamic instability . METHODS A three-group quasi-experimental design was used in this study , which was conducted in 2006 . A convenience sample of 105 patients was r and omly assigned to either the control or the two experimental groups ( A and B ) . The control group received routine care . Group B was treated only with modified positioning and group A with modified positioning and a pillow under their body .  Back pain , heart rate , arterial blood pressure , haematoma formation and bleeding were measured at regular time intervals . FINDINGS The control group experienced higher levels of pain after 3 , 6 , 8 hours and the morning after catheterization . The level of pain in group B was also higher than in group A at 3 hours after the procedure . Mean heart rate and blood pressure were lower in the experimental groups compared with the control group at 6 and 8 hours after catheterization . No statistically significant difference between the three groups regarding the amounts of overall ble 
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Discussion This review may have considerable implication s for practice and help to achieve an effective and efficient management of patients who underwent cardiac catheterisation .