The inclusion criteria are: elective or urgent primary cardiac surgery (coronary artery bypass

Graft (CABG); valve and double valve replacement; CABG plus single valve replacement); able to understand, speak, read and write English or have a suitable interpreter available; aged 18 years or over, and able to give informed consent. selleck chemical Lapatinib Exclusion criteria are: impaired renal function—creatinine level >200 or estimated-glomerular filtration rate <40; patients receiving: antiemetic medication within 24 h prior to surgery, or histamine H2-receptor antagonist within 24 h prior to surgery; skin damage (eg, burn scars) over PC6 area; wrist circumference >21 cm; and any previous experience of acupressure for nausea and/or vomiting, for example, related to morning sickness, chemotherapy or travel/motion sickness. Randomisation and allocation concealment Computer-generated random assignment will occur at the point of study entry, and

each patient will be allocated to a numbered trial group. Randomisation will involve a 1:1 ratio; stratified assignment by risk of nausea (Apfel Score that can be stratified into low (score 0 or 1), moderate (score 2), extremely high (score 3 or 4)25 at study site, with random variation in block sizes of 4–10. RRN will obtain a participant code number corresponding to a study pack to which each participant will be randomly allocated using a web-based independent automated service at the university Clinical Trials Randomisation Service, which is overseen by a biostatistician, and record the study group code in the patient’s medical record and on study forms. This process ensures adequate concealment, limiting likelihood

of selection bias.26 Processes to ensure blinding RRN will obtain the participant code number and, thus, is blinded to group allocation and will collect outcome data on day 4 postoperatively and document final nausea scale score at 36 h. Another RRN (RRN2, trained and assessed to ensure correct PC6 positioning) will apply the intervention/placebo on arrival in the ICU following surgery. All clinicians providing care will be blinded to group allocation. ICU and ward registered nurses will collect nausea scores and incidence of vomiting. All patients will be blinded to group allocation, as an occlusive bandage will be applied over the wristband. The acupressure wristband will be identical in appearance and Dacomitinib position for both intervention and placebo groups. All members of the research team involved in participant recruitment, randomisation and data collection, will be blinded to group allocation. Intervention Participants in the acupressure group will have a Seaband wristband applied on arrival to ICU on both wrists (bilateral application is recommended) by RRN2 ensuring that the bead stimulates the PC6 acupoint and the bands are covered with a light opaque bandage. The wristbands will be removed at 36 h after admission to ICU just after the final outcome measurement.