6 billion with 50% of this attributed to hospital care.4 As part of their treatment and recovery, cardiac surgery patients experience varying rates of PONV. Studies in the 1990s found rates of PONV in cardiac surgery patients of 22%5 47%6 and 50%.7 More recent studies reported rates of: 39–42% in a North American randomised controlled somehow trial (RCT);8 26–27% in a systematic review

of 10 RCTs;9 and 35% in a Canadian study.10 Patients report that they have a strong preference for avoiding PONV11 and, of 10 negative outcomes of surgery, rank vomiting as the most undesirable outcome and nausea as the fourth most undesirable.12 Patient dissatisfaction with anaesthetic care is strongly related to PONV.13 PONV can delay transfer from the recovery unit by up to 20 min12 and vomiting can place tension on sutures and wounds, produce imbalances in body electrolytes, and cause bleeding.12 Acupressure is a therapeutic intervention endorsed by the WHO14 and an alternative approach thought to prevent nausea and vomiting through an alteration in endorphins and serotonin levels. Efficacy of acupressure

for PONV Acupressure as a traditional Chinese medicine has been practised for centuries. The concept is based on life energy (Qi) flowing through channels known as meridians through the body.15 It is argued that acupressure restores equilibrium to disruptions affecting the body’s homeostasis by stimulating specific points (acupoints) that connect the meridians to organs.15 Although the mechanism for the action of acupressure has not been scientifically investigated fully, it is thought that it may prevent nausea and vomiting through an alteration in endorphins and serotonin levels.16 PC6 point stimulation for treating nausea and vomiting was reported in the early 1990s.17 The WHO (Western Pacific Regional Office) reached consensus on acupuncture point locations and published guidelines in

2008.18 The PC6 acupoint is the meridian point in the pericardium channel, and is located on the inner Batimastat forearm between the extensor carpi radialis and palmaris longus tendons, one-sixth of the distance from PC7 on the medial wrist crease to PC3 in the cubital fossa.18 Measuring the distance between the palmar wrist crease and inner forearm with a tape measure, and placing the bead on the wristband between the two tendons a sixth of the distance measured, is quick, acceptable and feasible in the clinical environment. This method is much more accurate than the previously used procedure of using the three middle fingers on the inside of the patient’s wrist to measure distance. Although the PC6 acupoint can be stimulated with a variety of methods (acu-stimulation device, acupressure, acupuncture, capsicum plaster), the important concept is stimulation of the correct acupoint.