"Unstoppable" oozing from angio site.

Specialties Cardiac

Published

Specializes in Cardiopulmonary Stepdown/Cath Lab, ICU.

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.

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Specializes in EP/Cath Lab, E.R. I.C.U, and IVR.

I have seen this multiple times especially if the patient was given any amount of Effient, Plavix, Integrilin, Angiomax, or Heparin. The tract ooze can continue for a while. What our providers like, as long as it is only ooze and capillary related, is Lidocaine with Epi. They simply take 2-3cc, and with out a needle drop the L/E into the tract while cleaning with gauze. This process can be repeated only a few times but works very well. Remember though that not all patients can handle even a small amount of epi that may be absorbed.

Jonathan

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Specializes in Cardiopulmonary Stepdown/Cath Lab, ICU.

I figured it was due to the fact he was given angiomax, heparin, and effient. Just the first time I've seen a site ooze like that for 14+ hours lol.

Never heard the Epi/lidocaine trick used on the floor, they may do that in the cath lab though, that's pretty cool and makes sense.

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Specializes in EP/Cath Lab, E.R. I.C.U, and IVR.

Actually we go and place L/E on the floor very often, usually when a dressing has been removed as well as the scab plug. All one needs is a MD order. It is very easy and effective.

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This happened to me last month. Drove me absolutely bonkers. After 4 hours of dressings and holding pressure I had the fellow come back. The lido with epi trick worked great. It was bleeding from the skin nick they do before the dilator was inserted. I was so ******. I spent all that time and he walks in and fixes it in 5 min. Can't use more than 10-12ml though.

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Specializes in Cardiopulmonary Stepdown/Cath Lab, ICU.

I've never seen it ordered on our floor.... Only been an RN a little over a year, but we get a lot of post caths and have not seen it once. I wonder why that is if it's so effective?

Would be great because this one Doc in particular's pts. ALWAYS ooze lol

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Specializes in critical care, ER,ICU, CVSURG, CCU.

how about ethicon skin glue?

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Specializes in Cardiology.

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.

Actually had an ooze last week. Another nurse took care of him the first night (when all the oozing was occurring) and I got him post-op the next night when the AV fistula in his groin, created by the sheath, was finally repaired by vascular surgery. He was not a happy camper.

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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?

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Specializes in Cardiopulmonary Stepdown/Cath Lab, ICU.
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?

Sarcasm I'm assuming,

Unless I've been taught wrong, the primary intervention when a hematoma is felt forming during, or just after a sheath is taken out is to reapply pressure to the site, as well as the hematoma and try to spread it out. Generally reducing size, amount of bruising, swelling etc.

Also in primary scenario this is occurring around 10pm, no doctor is bringing me anything or coming in to fix when it can wait until morning. I did talk to doc multiple times and all he wanted was to just apply a re-endforced pressure dressing and leave it til morning. Was a slow ooze, pt was in no danger/discomfort there was nothing else occurring at site until hematoma probably d/t plug at skin, but continued bleeding under tissue.

As I am relatively new didn't know about the L/E trick, as I've said I have not ever seen it ordered on our floor before.

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No, not sarcasm. It seems I have a tendency to confuse board members with my communication. It's not you, it's me.

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.

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I've been to hospitals where it is on their pre-printed post-cath orders. It is a great tool for groins like that but you have to have the order and generally a hospital policy regarding nurse administration. The epi in the lidocaine clamps down the tiny vessels in the tract. That's why dentists use lido w/ epi, less bleeding.

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