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New training allows nurses to start heart attack procedures

<div><span style="font-family: helvetica;"><img src="/nairobi/PublishingImages/Nurse%20led%20programme_body.jpg" alt="" style="margin: 5px; width: 890px; height: 336px;"/><em>Some of the nurses trained on the Nurse-led programme at the hospital cathlab</em></span></div><div><span style="font-family: helvetica;">
</span></div><div><span style="font-family: helvetica;">It is now understood that more people will die from coronary heart disease than any other cause of death in Africa by the year 2030. Coronary heart disease is caused by a narrowings in the main blood vessels that send blood to the heart, commonly known as coronary arteries. This narrowing forms a clot inside the blood vessel causing a heart attack, and immediate treatment to unlock the artery is needed to allow the heart to receive enough blood and enable it continue pumping blood to the rest of the body.</span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">“When a patient suffer heart attack, they often experience discomfort in the chest, arms, jaws or in the neck. Sometimes patients describe a gas sensation in the upper stomach and this is associated either with sweating or shortness of breath. This may be the only clue that the patient has had a heart attack. Once the patient arrives in hospital, the clock continues to tick. Treatment should be focused on unblocking the arteries as quickly as possible and the goal standard for this involves a procedure called coronary angiography and angioplasty”, says Dr Mohamed Jeilan, Cardiologist and Director, Cardiac Programme at Aga Khan University Hospital.</span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">In this procedure, specialists use a small puncture in the wrist to insert a very small catheter to the origin of the coronary artery, and inject some dye using a special x-ray equipment in order to see what condition the vessel is in. If the vessel is blocked, they will suck the clot out and may also open the narrowed arteries using a balloon or a stent. When conducted in experienced hands, this procedure called primary angiogram takes between 15 and 30 minutes. The procedure is usually performed under local anaesthesia, and involves an experienced team of specialist doctors as well as specialist nurses. </span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">“Sometimes the specialist doctors may not be onsite, and this might result in some delay in treatment. Nurses who have had extensive experience in heart attack management are now being trained to get the first half of this procedure started with the Nurse led radial access angiography initiated at Aga Khan University Hospital for the first time in the region.” </span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">“The advance cardiology intervention technique training programme will allow nurses to take the front line in the treatment of heart attack patients.  This involves allowing them to access the radial artery in the patient’s wrist by inserting a thin tube known as the sheath in the catheterization laboratory as they wait for the cardiologist to arrive and prepare. When ready, the cardiologist then inserts a catheter, a longer thin plastic tube which advances to the heart.  This provides the information for diagnosing and treating the heart.”    </span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">“In order to get them ready to carry out this procedure we are training specialised nurses in the catheterization laboratory. Once they have fully mastered this advanced cardiology intervention technique they can become specialists and be able to access initial heart surgeries without supervision”, notes Dr Mohammed Jeilan.</span></div><div><br style="font-family: helvetica;"/></div><div><span style="font-family: helvetica;">Part of the training involves an audit process to determine how effective the nurses have become and to ensure that safety and quality are preserved. After it has been demonstrated to be both safe and effective, the Cardiac Programme of Aga Khan University Hospital intend to run a specific training course in collaboration with other medical partners on radial access for institutions that are keen to improve their efficiency in heart management in the absence of a cardiologist.     </span></div><div><br style="font-family: helvetica;"/></div>