"Unstoppable" oozing from angio site.

[TopsDrop]

Pt. came in with chest pain, went to cath lab, no interventions were needed, so he was supposed to come to floor and get 2 hours of bedrest and head home.

We pull his sheath, hold pressure for ~40 min. Still oozing from site, okay hold a little more pressure, then put pressure dressing on and 10 lb bag. He is staying the night.

Anyway after talking to Doc ~4 times over 4 hours (he was calling me couple times) explaining the site is still oozing, but otherwise fine, even after holding additional pressure and trying everything in my power to stop the bleeding he has me apply different pressure dressing and leave it til morning (I work third shift). No complaints from pt. until 6am, site is still oozing and he now has some pain because he has a hematoma forming. I push it out, hold more pressure and site feels perfect again but is STILL OOZING.

Doc eventually came in that morning and had to suture site closed. Obviously it wasn't arterial and was from the puncture site, but has anyone had anything like this? We're talking 12 hours of slooow ooze. Had to have held ~2 hours pressure total.

[TopsDrop, RN]

When you said "push out" the hematoma I was envisioning you're squeezing it out like a pimple!! Now an intervention like THAT I've never heard of but I was curious to hear about it. But yeah...reapplying pressure is pretty standard.

No worries, but your comment just made me roll around laughing trying to envison doing that and how massive a "pimple" that would be lol

[Esme12, ASN, BSN, RN]

Wait, what? Tell me about "pushing out" a hematoma.

Also, what's this sand stuff in a tiny vial I found once at my patient's bedside that a doc brought to stop a bleed? Is it some magic dust?

The magic dust is called "surgicel" absorbable hemostat that is a powder or small gauze like substance. Pushing out a hematoma is the general principle or "popping/squeezing a pimple" get the blood out from under the skin to shrink/get rid of the hematoma.

[gwapo]

Chitoseal is the magic dust :) there is also called a surgiseal. Not sure of the spelling. Just call ER, they should have it. And surgiseal is usually in a wound cart (if u have that).

[delphine22]

Our magic powder is called stat seal, we keep it on the floor. It has a little adhesive ring you put around the puncture site, you sprinkle the powder in, as soon as it hits blood it congeals. Works great on oozing PICC sites too. Never heard of epi/lido used on our post-cath floor but I will ask tonight. :-)

[Penelope_Pitstop, BSN, RN]

We use femostops.

[michlynn, BSN, RN]

We keep Bupivacaine handy for oozing like that. Just inject around the cath site to stop the capillary bleeding.

[canned_bread]

Have you guys got Fem-stops? We use those for bleeding that won't stop - they are a great invention. Maybe something to speak to the cath-lab about.

What might have occurred is the pressure was being held over the puncture site, whereas the actual entry of the sheath is above that. It goes in at an angle. So maybe you were holding pressure over the superficial site, and not where the bleeding was occurring.

As for the haematoma, if it's large it's quite important to "massage" it out. It is painful for the patient, so sometimes an order of fentanyl might have to be given if it's large enough. It just requires massaging the whole area very firmly until soft (whilst placing pressure on the insertion site in case you blow the plug).