Effect of Stress Ball Use During Femoral Arterial Sheath Removal After Coronary Angiography

Coronary angiography is a commonly used invasive procedure for the diagnosis and treatment of coronary artery disease. Following coronary angiography performed via the femoral artery, removal of the femoral arterial sheath may cause pain and anxiety and may lead to changes in hemodynamic parameters. Therefore, simple, safe, and nonpharmacological nursing interventions that can improve patient comfort during femoral arterial sheath removal are important.

This prospective, two-arm, randomized controlled trial aims to evaluate the effects of stress ball use during femoral arterial sheath removal after coronary angiography on pain, anxiety, patient satisfaction, and hemodynamic parameters. The study will include 34 patients who meet the eligibility criteria. Participants will be randomly assigned in a 1:1 ratio to either the stress ball intervention group (n=17) or the control group (n=17) using block randomization.

Participants assigned to the intervention group will receive a stress ball immediately before femoral arterial sheath removal. A round, medium-firm silicone stress ball approximately 6 cm in diameter will be used. Participants will be instructed to hold the stress ball in their hand and rhythmically squeeze and release it after counting to three. The intervention will begin approximately one minute before femoral arterial sheath removal and will continue during and after sheath removal for a total of 10 minutes. Participants in the control group will receive routine clinical care without any additional nonpharmacological intervention.

Pain intensity will be assessed using the Visual Analog Scale (VAS), anxiety using the Visual Analog Scale for Anxiety (VAS-A), and patient satisfaction using the Visual Analog Scale for Patient Satisfaction (VAS-PS). Hemodynamic parameters will include systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation (SpO2).

Assessments will be performed at five predefined time points: immediately before femoral arterial sheath removal (T0), immediately after sheath removal (T1), and at 5 minutes (T2), 15 minutes (T3), and 30 minutes (T4) after the procedure. Routine medical treatment and nursing care will be continued for participants in both groups throughout the study.

The primary outcome of the study is pain intensity associated with femoral arterial sheath removal. Secondary outcomes include anxiety, patient satisfaction, systolic and diastolic blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation. The findings are expected to provide evidence regarding the effectiveness of stress ball use as a simple, low-cost, noninvasive nursing intervention during femoral arterial sheath removal after coronary angiography.

Inclusion criteria

• Patients who underwent coronary angiography via the femoral artery and received stent implantation or balloon angioplasty
• Aged 18 years or older
• Willing to participate in the study and providing written informed consent
• Conscious, oriented, and cooperative
• Able to read and understand Turkish
• No hearing or visual impairment that would interfere with participation
• Clinically and hemodynamically stable
• No diagnosed psychiatric disorder

Exclusion criteria

• Coronary angiography performed via the radial artery
• Development of a complication during coronary angiography, such as arrhythmia
• Administration of sedation during coronary angiography
• Pregnancy
• Prisoners or other vulnerable individuals