In "Pump Away Angina with EECP" (January 2004), the author made two incorrect statements that could jeopardize patients undergoing enhanced external counterpulsation. First, she asserts that each EECP session is 60 to 90 minutes in duration. No literature supports a single EECP session lasting any longer than 60 minutes. The hemodynamic effects of extending treatment beyond 60 minutes isn't clear and this is not the standard of care.
Second, she writes, "if a patient complains of tightness in his legs, decrease the pressure to 0.02 MPa." This instruction is baseless and potentially dangerous. A patient with left ventricular dysfunction must be treated at the full prescribed pressure in order to provide adequate myocardial unloading. Treating such a patient at half-pressure would increase venous return without providing adequate myocardial unloading, which could throw the patient into acute pulmonary edema and crisis.
DEBRA BRAVERMAN, MD
Standard EECP treatment consists of one 60-minute session 5 days a week for 7 weeks. More time would be added as treatment days, not minutes, and requires approval from the attending physician and insurance company.
Leg and buttock cuffs should be connected to hoses before they're placed on the patient. It would be possible but awkward (and definitely not standard care) to place the cuffs on the patient and then attach hoses to couplings, as shown in your article. Also, the cuffs and belts pictured are out of date-newer equipment features self-adhesive cuffs that are more patient-friendly.
The nurse should begin therapy with the pressure set at 0.0 MPa, then slowly increase pressure to 0.04 MPa over 2 to 5 minutes. If the patient complains of tightness, the nurse should turn the pressure down and off, then rewrap the legs, making sure to smooth the treatment pants to eliminate wrinkles under the cuffs and adding padding if necessary. Decreasing the pressure as you suggested would increase the patient's risk of heart failure and do him no good from a treatment standpoint.
CHERYL MARKS, RN
FLORENCE ZELINKA, RN
The comments appearing in this column are excerpted from readers' correspondence. Send your letter, complete mailing address, and credentials to: Letters Editor, Nursing2004, 323 Norristown Rd., Suite 200, Ambler, PA 19002, or e-mail to firstname.lastname@example.org. Please include your e-mail address and daytime telephone number.