Cho E, Jang MR, Moon JR, Kim MJ, Kim YM, An YJ, Kang IS, Song J.Heart Lung. 2023 Jul-Aug;60:52-58. doi: 10.1016/j.hrtlng.2023.02.023. Epub 2023 Mar 11.
Take Home Points:
- Minimizing supine bedrest time for pediatric patients following cardiac catheterization can have a significant impact on the stress for the patient and their family.
- The standard 4 to 6 hours of supine bedrest that many centers practice may be more than is needed.
- Further studies with a larger cohort of patients that include analysis of sheath size in comparison with patient size could help answer this question more thoroughly

Commentary from Dr. Ryan Romans (Kansas City, MO), section editor of Congenital Heart Disease Interventions Journal Watch:
Patients who undergo cardiac catheterization via the femoral vessels require supine bedrest following the procedure. While there is significant central variation, this is frequently done for 2 to 6 hours. This can be challenging in the pediatric population, especially in younger patients. They may require sedative medications to assist in ensuring adequate immobility of the leg to prevent complications such as bleeding or hematoma development. Recent adult studies have shown that 1.5 to 2 hours of supine bedrest is adequate. However, there is a much wider variability in case duration and sheath size used in pediatric patients. Given this, the authors thought to determine if there were differences in bleeding incidents, vascular complications, need for sedatives, and pain in patients who are required to complete 2 (experimental group) versus 4 (control group) hours of supine bedrest.
A prospective, randomized open label trial was performed from 10/21 to 5/20/2022. The study included patients who were between 30 days and 16 years old. Patients with congenital bleeding disorders, in whom femoral vessel access was difficult, those requiring emergency cardiac catheterizations, those requiring ICU level care following the catheterization, and those with an ACT >250 seconds following the catheterization were excluded. Bleeding and vessel complications were identified via inspection and palpation and scored as a 0 if there was no bleeding, 1 if there was a small amount of bleeding, 2 if there was a palpable hematoma and/or severe bleeding and 3 if there was arterial occlusion/aneurysm/AV fistula/abdominal hematoma). Pain was assessed using verified rating scales (face–legs–activity–cry–consolability in <3 years, face pain rating scale 4-6 years, and numeric rating system 7 years and older). At the occlusion conclusion of the case, an ACT was checked, and sheaths were removed. Clo-Sur plus hemostatic pads were applied to all patients and manual compression was performed until hemostasis was achieved. A sandbag was placed on the site prior to leaving the cardiac catheterization lab. Bleeding, vessel complications, pain at the access site, and administration of analgesics were evaluated every hour for 4 hours and again in 18 hours in both groups. A total of 84 patients were randomized (42 in each group). Patients in the experimental group were slightly younger, smaller, and more likely to be taking aspirin or warfarin prior to their procedure than those in the control group. There were no statistically significant differences in bleeding incidents, vessel complication, pain scores or sedative administration between the groups (no bleeding or vascular complications were seen in either group).
This study sought to determine the amount of supine bedrest time needed in pediatric patients following a cardiac catheterization. There is certainly value in determining this as it can be challenging, especially for younger patients, to remain supine following procedures. The authors showed that 2 hours appears to be an adequate amount of supine bedrest time following a cardiac catheterization at their center and a small number of patients. However, more data on this is likely needed before more widespread adoption of this practice. The center where the catheterizations were performed used sandbags on all access sites. This is not necessarily a standard practice at many pediatric centers as it can be quite uncomfortable. They did not seek to evaluate whether sheath size used for the procedure has an impact on bleeding/vascular complication risk, pain, and potential need for longer supine bedrest. Before universally adopting 2-hour bedrest, it would be useful to determine if a sheath size to patient weight ratio placed patients at higher risk for bleeding and/or vascular complications.