When you get a patient fresh from the cath lab, with a pressure dressing in place, how do you assess the site? I ask d/t a disagreement with a cath lab nurse yesterday when they brought my patient back (I've had countless post-cath patients, but for some reason, this nurse took issue with the way I checked the site). Thanks in advance.
Apr 26, '11
The way I assess my patients, as is protocol in my hospital, is by comparing both groins, palpating to make sure the site is soft and no hematomas are felt or seen. Then, I assess pedal pulses and compare them to their baseline (if the patient has been on the floor for a while) and continue to assess every hour to two hours, with vital signs per policy. What is the policy/protocol in your hospital?
Apr 26, '11
On my floor, we assess the site, BP and pedal pulses q15 min for one hour, q30 min for one hour, then hourly for four hours, then q2h for four hours. The problem I am having is this: all my patients come up with a pressure dressing tha that has a long edge free to slip your fingers under, to assess the cath site over the opsite that holds the gauze in place. This nurse insisted I didn't have to see/feel under the dressing; that palpating around the dressing is sufficient. Every nurse I talked to on the floor disagreed -- we all feel under the dressing. Charge nurses and colleagues are all on the same page. I don't care if she disagrees with me, but I do care that she berated me in front of my patient. But regardless, I don't want to be wrong and somehow compromise patient safetry.
Apr 27, '11
We do not use pressure dressings, the thinking being that they do not promote hemostasis but can hide a hematoma. Same thing with sandbags.
We use gauze/opsite, or just recently, bandaids over the latest, greatest hemostatic patch.
So we visualize and gently palpate the site, and assess pulses.
The frequent vitals are done in the CRU q15min x4 for diagnostic, q15min x4, q30 min x2 for PCIs. When patients reach the floor VS, site and pulse checks are done q4h, more freq. at the nurses' discretion.
May 1, '11
We pull our sheaths on the floor unless an angioseal is used down in the cath lab. After a sheath pull we assess the site q15min for 1 hour, q30 min for 1 hour, and hourly until the patient is off bed rest. We just use a piece of gauze with a clear op site over or a piece of tape. You definately need to feel underneath a large pressure dressing because like previous people said, a large pressure dressing can hide a hematoma.
May 2, '11
We no longer use pressure dressings either but if I had one I'd definitely feel underneath! We check the site and compare groins, check VS and pedal pulses q 15 min x 4, q 30 min x 4, q 1 hr x 4 and then q 4 hr x 4.
Jun 4, '11
Pressure dressings are dangerous (not to mention mean to post-pubescents!), and no more effective at preventing bleeding. Consider this article from American Journal of Critical Care:
Also - don't forget to listen for a bruit, which could indicate pseudoaneurysm or AV fistula!
Jun 5, '11
This nurse sounds like a *****/jerk, honestly. You assess the site however you feel confident doing it. At the end of the day, you need to go home feeling as though you kept your patient safe and used your assessment skills to accurately and thoroughly check for complications.
Why do all your patients have wedge dressings? Do you guys not use angioseals?
Personally, I always poke my fingers underneath the wedge if I can. Lots of times a pt's....uhh...body habitus prevents one from getting underneath there. But then I just palpate around it, and rely on my vital signs, pt complaints, pedal pulses.
Don't let someone else's criticism of your thorough assessment get to you. I had an EP lab nurse make a rude comment to me about pacer pads for transport once. She was like "well what good are the pacer pads in your bag?! You should put them on the patient!" Yeah, for our 3 minute trip to the EP lab with a stable patient. I'm totally gonna slap those pads on, *****.