Algorithm for bed bath in acute myocardial infarction: a methodological study

Viviane de Moraes Sptiz1,2, Silvia Regina Martins dos Santos1,3,4, Anna Beatriz Alves Pereira Lôbo1,5, Fernanda Faria Reis1,5, Lucélia dos Santos Silva1,6, Dalmo Valério Machado de Lima1
1Universidade Federal Fluminense
2Secretaria de Saúde do Estado do Rio de Janeiro
3Universidade do Estado do Rio de Janeiro
4Universidade Veiga de Almeida
5Hospital Estadual Alberto Torres
6Secretaria Municipal de Saúde do Rio de Janeiro


Aim: it is intended to construct an algorithm to indicate bathing in bed in the hospitalized adult patient with acute myocardial infarction. Method: This is a methodological study carried out between March 2015 and January 2016, based on the literature review and the databases PUBMED, LILACS, WEB OF SCIENCE, CINAHL and COCHRANE, with a time cut from 2010 to 2015 and data from a clinical study conducted with 19 adult patients from June to November 2015, in a private hospital in Niterói, Brazil. Statistical analysis will be done through correlation and logistic regression of variables: bath duration and time, water temperature, type of infarction, positioning, heart rate, blood pressure, peripheral oxygen saturation, myocardial oxygen consumption and systolic volume. To build the algorithm, we will use the freeware Bizagi BPMN Modeler version 3.0. Content validation will be carried out through a meeting with experts, recruited through the Lattes Platform.

Descriptors: Baths; Myocardial Infarction; Algorithms; Hemodynamics; Oximetry.


Bathing in the bed is an exclusive activity of nursing and is part of the daily care provided to patients hospitalized in the Intensive Care Units. In a study that evaluated the impact of bathing in the bed on the time of weaning of patients on mechanical ventilation, it was evidenced that the bath did not increase the time of weaning, contradicting the expectation of the clinical practice. The presence of the nurse was considered a positive factor, suggesting that, during bath, patients receive more attention and comfort, which promotes well-being and it influences positively the recovery of the patient(1). However, bathing in the bed can trigger some physiological changes. A study that evaluated the oxy-hemodynamic repercussions in patients in the postoperative period of cardiac surgery showed statistically significant alterations(2) in heart rate and systolic blood pressure.

In the last decades, a great concern has arisen in term of patient safety. When searching the main databases in the last five years, there was a small scientific material and lack of a decision-making tool for the bed-bathing practice in infarcted patients, justifying the present proposal. The bath algorithm will subsidize a quality care practice in order to promote patient safety and minimize aggravating factors.


A pre-bath evaluation algorithm, applied by nurses, will aid the decision making in order to ensure that infarcted patients are bathed safely.


The aim is to construct algorithm for indication of bed bath in the hospitalized adult patient with acute myocardial infarction.


This study is part of the activities of the Professional Master's Degree in Nursing Care of the Fluminense Federal University. This is a methodological study based on data collected from an uncontrolled randomized clinical trial developed at the Coronary Unit of a private hospital in Niterói from June to November 2015, and by reviewing the literature in the databases PUBMED, LILACS, WEB OF SCIENCE, CINAHL and COCHRANE with a temporal cut from 2010 to 2015, using the descriptors Baths, Myocardial Infarction, Algorithms, Hemodynamics, and Oximetry from March 2015 to January 2016. Eighteen articles on bathing in the bed in the intensive therapy were selected for the theoretical basis of the research.

The clinical trial was a convenience sample of 19 infarcted adult patients who underwent two bed baths on consecutive days, one with constant water temperature control at 40º and one without constancy at the water temperature. Both were monitored by ICG CardioScreem 2000 MEDIS. The inclusion criteria in this clinical trial were: adult patients with Killip-Kimball I and II myocardial infarction within 48 hours of the onset of the event, who had completed both baths. The exclusion criteria were: postoperative patients with cardiac surgery with chronic heart failure, with bath time of more than 20 minutes and with pathologies that could compromise the accuracy of ICG, such as septic shock, aortic valve problems or the presence of prosthesis aortic balloon, severe hypertension, tachycardia (above 200bpm), height smaller than 120cm or greater than 230cm, weight smaller than 30Kg or over 155 Kg, and the presence of intra-aortic balloon. Data from the literature and from the clinical trial will provide support to the construction of the algorithm, and the freeware Bizagi BPMN Modeler version 3.0 will be used.

Current and past health sociodemographic data will be used to analyze the sample profile. The independent variables will be bath duration, water temperature, bath time, type of infarction and positioning and dependent variables, heart rate, blood pressure and mean, peripheral oxygen saturation, myocardial oxygen consumption, and systolic volume. For the statistical analysis, multivariate logistic correlation and regression tests will be performed.

To validate the content of the algorithm, a committee of experts will be formed based on a curricular search in the CNPq Lattes Platform. The inclusion criteria will be: doctors with Brazilian nationality who have published studies or investigated bed bath, cardio intensity, acute myocardial infarction and studies of hemodynamic changes during bath, systematization of nursing care, patient safety and non-doctoral professionals who have experience in clinical care. Based on the article by Alexander and Coluci(3), five experts will be recruited to form the committee.

A questionnaire will be sent to the experts by electronic means, using the Delphi Technique, with statements about the content that should compose the algorithm. After the answers are returned, the concordance evaluation will be carried out through the Kappa Concordance Index.


  1. Sereika SM, Tate JA, DiVirgilio-Thomas D, et al. The association between bathing and weaning trial duration. Heart Lung. [Internet]. 2011 Jan-Feb [cited 2016 Oct. 20];40(1):41-8. Available from: doi: doi: 10.1016 / j.hrtlng.2010.03.005.
  2. Madrid SQ, López CC, Otálvaro AFT, Padilla LMR. Alteraciones hemodinámicas del paciente crítico cardiovascular durante la realización del baño diario. Medicina U.P.B. .[Internet]. 2012 Ene-Jun [cited 2016 October 20] 31(1):19-26. Available from:
  3. Alexandre, NMC, Coluci MZO. Validade de conteúdo nos processos de construção e adaptação de instrumentos de medidas. Ciênc. saúde coletiva. [Internet]. 2011 July [cited 2016 Jan 27] 16(7):3061-68. Available from:

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Received: 09/08/2016 Revised: 10/31/2016 Approved:10/31/2016