Research ArticleResearchQuality Improvement

Randomized trial finds nurse-delivered acupressure significantly lowers pain scores and heart rates in infants undergoing cardiac catheterization

The Journal of Cardiovascular Nursing (PubMed)Sep 30, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

In a randomized placebo-controlled trial of 60 infants undergoing cardiac catheterization for congenital heart disease, nurse-delivered acupressure applied before and after the procedure significantly reduced FLACC pain scores, lowered heart rate, and reduced rescue analgesic use.

What NurseJet pulled from the source

Infants with congenital heart defects routinely undergo diagnostic and interventional cardiac catheterization, which triggers acute pain, autonomic stress, and hemodynamic destabilization. This randomized, placebo-controlled trial enrolled 60 infants aged 1 to 12 months undergoing catheterization in a pediatric cardiac surgery unit, assigning them equally (n=20 per arm) to acupressure, placebo touch, or standard control. The intervention applied targeted acupressure to the Shenmen (HT7), Hegu (LI4), and Neiguan (PC6) points before and after catheterization. Infants receiving acupressure exhibited statistically significant reductions in Face, Legs, Activity, Cry, Consolability (FLACC) pain scores across all postprocedural evaluation intervals compared with placebo and control groups. Heart rate was also significantly lower during postprocedural monitoring, and fewer infants in the acupressure group required supplemental analgesics, while oxygen saturation improved over time across cohorts.

Why this matters for nurses

Managing procedural discomfort in fragile cardiac infants is challenging because sedative and opioid analgesics carry risks of respiratory depression, hypotension, and altered pulmonary vascular resistance. Demonstrating that a zero-cost, non-invasive acupressure technique delivers measurable pain relief and autonomic stabilization empowers pediatric nurses with an evidence-based adjunctive tool.

Bedside takeaway

In 60 infants undergoing cardiac catheterization, nurse-administered acupressure at HT7, LI4, and PC6 significantly reduced FLACC pain scores, lowered heart rate, and decreased analgesic requirements.

Key takeaways

Randomized placebo-controlled trial evaluated 60 infants aged 1–12 months with congenital heart disease undergoing cardiac catheterization.
Acupressure applied to HT7, LI4, and PC6 points significantly lowered FLACC pain scores across all postprocedural time points.
Infants in the acupressure group maintained significantly lower heart rates post-procedure compared to placebo and control groups.
Post-procedural supplemental analgesic administration was significantly less frequent in infants receiving targeted acupressure.

Practice implications

Consider integrating gentle, non-pharmacologic acupressure at validated points (HT7, LI4, PC6) alongside standard comfort positioning and developmental care for infants undergoing invasive vascular access or cardiac procedures, tracking objective FLACC scores to evaluate response.

Limitations & cautions

Single-center study with a sample size of 60 infants; blinding of procedural staff and data collectors to the tactile intervention is inherently challenging in complementary care trials.
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Citations

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The Journal of Cardiovascular Nursing (PubMed)

The Journal of Cardiovascular Nursing (PubMed). Does a Simple Touch Make a Difference? The Effect of Acupressure on Pain Scores in Infants Undergoing Cardiac Catheterization: A Randomized, Placebo-Controlled Trial.

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https://pubmed.ncbi.nlm.nih.gov/42814763/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Clinical research in cardiology : official journal of the German Cardiac Society (PubMed)Sep 28, 2026Research Article

A prespecified sex-specific secondary analysis of the PUSH-AHF trial in 310 patients found natriuresis-guided diuretic therapy increased 24-hour sodium excretion and reduced 180-day mortality or heart failure readmission in men, but not in women.

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Natriuresis-guided loop diuretic titration uses spot urinary sodium measurements to tailor decongestive therapy in acute heart failure (AHF). In this sex-specific analysis of the randomized PUSH-AHF trial, investigators evaluated 310 patients (45% women) assigned to natriuresis-guided therapy versus standard of care. In men, natriuresis-guided therapy produced significantly greater mean 24-hour total natriuresis compared with standard care (443 vs 354 mmol, p = 0.004), whereas women showed no significant difference between treatment arms (357 vs 336 mmol, p = 0.533; adjusted p-interaction = 0.276). Notably, the median 24-hour natriuretic response per milligram of loop diuretic (bumetanide equivalents) was significantly lower in women receiving natriuresis-guided therapy than standard care (23 vs 52 mmol/mg, p = 0.001), while no difference was observed in men (38 vs 45 mmol/mg, p = 0.337; adjusted p-interaction = 0.009). Clinically, natriuresis guidance was associated with a 49% lower risk of 180-day all-cause mortality or HF rehospitalization in men (adjusted HR 0.51; 95% CI, 0.30–0.86; p = 0.011), but showed no benefit in women (adjusted HR 1.40; 95% CI, 0.67–2.91; p = 0.368; adjusted p-interaction = 0.026).

Key takeaways

Sex-specific analysis of the PUSH-AHF randomized trial evaluated 310 patients (45% women) with acute heart failure.
In men, natriuresis-guided therapy increased 24-hour urinary sodium excretion (443 vs 354 mmol, p = 0.004) and reduced 180-day mortality/rehospitalization by 49% (adjusted HR 0.51, p = 0.011).
In women, natriuresis guidance did not increase total natriuresis (357 vs 336 mmol, p = 0.533) or improve 180-day clinical outcomes (adjusted HR 1.40, p = 0.368; p-interaction = 0.026).
Women in the guided arm exhibited a blunted natriuretic response per milligram of loop diuretic (23 vs 52 mmol/mg bumetanide, p = 0.001).

Why this matters on shift

Cardiology and telemetry nurses frequently manage intensive loop diuretic infusions and collect spot urinary sodium samples during acute decompensated heart failure admissions. These findings demonstrate that diuretic responsiveness and natriuresis-guided protocols may operate differently by biological sex, warning clinicians that intensifying diuretic doses based solely on spot sodium targets may not yield uniform decongestive or prognostic benefits across all patient groups.

Bedside takeaway

In the PUSH-AHF trial (310 patients), natriuresis-guided diuretic therapy reduced 180-day mortality/readmission in men (aHR 0.51) but showed no benefit in women (aHR 1.40; p-interaction=0.026).

Nursing implications

Collect urine samples for spot sodium strictly at ordered intervals during acute decongestion, maintain accurate intake/output records, monitor serum electrolytes and renal function closely during diuretic uptitration, and recognize that blunted urinary sodium output in female patients may reflect altered pharmacodynamics rather than simple noncompliance with fluid restrictions.

Limitations & cautions

Post-hoc subgroup analysis of a randomized trial with limited sample size (n = 310, including 139 women); findings are hypothesis-generating and require prospective validation in sex-stratified clinical trials before modifying clinical guidelines.
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Citations · exact source links

Clinical research in cardiology : official journal of the German Cardiac Society (PubMed). Effects of natriuresis-guided diuretic therapy in men and women with acute heart failure: insights from PUSH-AHF.

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Pediatrics (PubMed)Oct 1, 2026Clinical Guideline

The American Academy of Pediatrics updated its clinical practice guideline for diagnosing and managing urinary tract infections in infants and children aged 8 days to 5 years with low medical complexity.

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Urinary tract infections (UTIs) occur in approximately 7% of febrile infants and represent one of the most common bacterial infections in pediatric practice. Replacing the 2011 guidance, the American Academy of Pediatrics issued an updated clinical practice guideline with three companion technical reports for children 8 days to 5 years of age with low medical complexity. Developed using the GRADE framework with evidence-to-decision panels, the update provides eight Key Action Statements (two strong and six conditional recommendations ranging from low to very low certainty of evidence) and four Good Practice Statements. Core guidance spans the diagnostic evaluation of suspected UTI, targeted antimicrobial selection and treatment duration, indications for renal and bladder ultrasound and voiding cystourethrography, prevention of structural sequelae including vesicoureteral reflux, and structured screening and treatment for bowel and bladder dysfunction.

Key takeaways

AAP updated its pediatric UTI guideline for children aged 8 days to 5 years with low medical complexity.
Formulates 8 Key Action Statements (2 strong, 6 conditional) and 4 Good Practice Statements using GRADE methodology.
Refines diagnostic sampling criteria, acute antibiotic selection, and targeted duration to minimize antimicrobial resistance.
Updates indications for renal imaging, vesicoureteral reflux evaluation, and systematic management of bowel and bladder dysfunction.

Why this matters on shift

Pediatric and emergency nurses are central to identifying febrile infants at risk for UTI, executing proper catheterized or clean-catch urine specimen collection, and guiding families through antibiotic completion and scheduled follow-up imaging. Standardizing diagnostic thresholds prevents both delayed pyelonephritis treatment and unnecessary antibiotic exposure in young children.

Bedside takeaway

AAP updated its pediatric UTI guideline for children 8 days to 5 years, delivering 8 Key Action Statements on diagnostic sampling, targeted antibiotic therapy, imaging indications, and bowel-bladder dysfunction.

Nursing implications

Collect clean catheterized urine specimens rather than bag samples for culture in non-toilet-trained febrile infants, reinforce completing prescribed antibiotic courses with parents, and assess older toddlers for withholding and bowel/bladder dysfunction during discharge education.

Limitations & cautions

Guideline applies specifically to children with low medical complexity and excludes those with neurogenic bladder, known high-grade anatomical urological anomalies, or immunodeficiency; evidence certainty for several recommendations remains low to very low.
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Citations · exact source links

Pediatrics (PubMed). Clinical Practice Guideline for the Diagnosis and Treatment of Urinary Tract Infection in Children From 8 Days to 5 Years of Age.

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AI-summarized from the linked source. Review the original article before applying to practice.

JAMA (PubMed)Oct 13, 2026Research Article

In a multicenter phase 3 trial of 989 actively bleeding cardiac surgery patients undergoing cardiopulmonary bypass, cold-stored platelets preserved up to 21 days met noninferiority criteria compared to standard 7-day room-temperature platelets for hemostatic control and 24-hour chest tube drainage.

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Platelet shortages and brief 5- to 7-day room-temperature storage limits frequently challenge hospital blood supplies and acute perioperative transfusion support. The phase 3 CHIPS trial was a multicenter, randomized, partially blinded, adaptive noninferiority trial conducted across 27 hospitals in the United States and Australia. The trial evaluated whether cold-stored platelets (CSPs; 1–6 °C, stored up to 21 days) were noninferior to standard room-temperature platelets (RTPs; 20–24 °C, stored up to 7 days) in patients with active surgical bleeding during or after cardiac surgery with cardiopulmonary bypass. Among 1,000 patients randomized 2:1 and 989 included in the primary analysis (650 CSPs, 339 RTPs; mean age 42.1 years; 67.8% male), CSPs were noninferior to RTPs for the primary 5-point hemostatic efficacy score across all storage durations (>99.9% posterior probability of noninferiority; pooled mean difference 0.09; 95% credible interval -0.06 to 0.23). Median 24-hour chest tube output was similar between groups (8.9 mL/kg for CSPs vs 8.4 mL/kg for RTPs; difference 0.4 mL/kg; 95% CI -1.0 to 1.5). Rates of arterial and venous thrombotic events, ARDS, acute kidney injury, septic shock, and mortality showed no significant differences, although surgical reexploration was higher in the CSP cohort.

Key takeaways

Phase 3 adaptive trial across 27 centers in the US and Australia randomized 1,000 cardiac surgery patients with active surgical bleeding.
Cold-stored platelets preserved up to 21 days demonstrated noninferior hemostatic efficacy compared to room-temperature platelets (>99.9% probability).
Twenty-four-hour chest tube drainage showed no significant difference between cold and room-temperature platelets (8.9 vs 8.4 mL/kg).
Adverse safety endpoints including thrombosis, septic shock, and mortality were comparable, with higher surgical reexploration noted in the cold-stored group.

Why this matters on shift

Cardiac and critical care nurses routinely infuse platelets to control coagulopathic bleeding after cardiopulmonary bypass and closely monitor postoperative mediastinal drain outputs. Extending platelet shelf life from 7 to 21 days through cold storage could dramatically reduce product waste and eliminate critical shortages during emergency surgical resuscitation.

Bedside takeaway

In a 989-patient trial of bleeding cardiac surgery patients, cold-stored platelets up to 21 days were noninferior to standard room-temperature platelets for hemostasis (mean diff 0.09), with similar 24-hr chest tube drainage (8.9 vs 8.4 mL/kg).

Nursing implications

Monitor post-bypass chest tube drainage volumes hourly, confirm platelet storage temperature and expiration integrity before transfusion, and remain vigilant for signs of active postoperative hemorrhage and indications for surgical reexploration.

Limitations & cautions

Partially blinded trial design; single-product evaluation focused strictly on cardiopulmonary bypass surgery; increased reexploration rate in the cold-stored group warrants careful clinical surveillance.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

JAMA (PubMed). Cold and Room-Temperature Platelets in Cardiac Surgery: The CHIPS Randomized Clinical Trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

PUSH-AHF trial analysis finds natriuresis-guided diuretic therapy reduces 180-day events in men but not women with acute heart failure

AAP updates pediatric UTI clinical practice guideline with 8 key action statements for children 8 days to 5 years

CHIPS randomized trial finds cold-stored platelets up to 21 days noninferior to room-temperature platelets for bleeding in cardiac surgery