Hi, I work on a Tele/med unit, and we get post cath patients with or without percutaneous interventions (i.e. stenting).
First, there are lots of different closure devices for the insertion site, which is usually the groin, but sometimes they use the brachial in the arm. For each device the bedrest time is different.
We use 3 most commonly at our hospital.
Boomerang- has a coagulant on the tip, which decreases bedrest (usually 2-3 hours) and decreases hold time (the time pressure is held manually after pulling the sheath). The coagulant also assists in healing.
Syvek- same bedrest and hold time as the boomerang.
Angioseal- bedrest is 5-6 hours. It is a collagen plug that is absorbed in the body within 90 days. This hold time is 20 minutes.
We RARELY use sandbagging at the hospital, and sheaths are not pulled on our unit. They are pulled in the cath lab or ICU by nurses with special training to do this.
As for what we assess:
We look at the site: is it swollen? is there bruising? is the dressing C/D/I, or is there drainage? Is the drainage old (dried, brown) or is it fresh (bright red)? If there is drainage, how much? Is the dressing saturated, or just spotted?
We also palpate the site. It should be soft,andnon or mildly tender.
Also palp distal pulses. They should be equal and the same as pre cath.
Palpation of the cath site will tell you if there is a problem. Here are a few:
A firm raised area with or without bruising that is very painful with definite edges you can feel means there is a hematoma, and it may still be bleeding. We mark the edges and hold pressure 2-3 cm ABOVE the insertion site until the bleeding stops or the hematoma is not getting bigger. Watch VS, and keep B/P <150/80. Check B/P every 5 minutes. Insert a foley to keep the bladder empty because a full bladder can keep pressure at the site in the wrong place and cause more bleeding. Call your MD. Give pain meds if needed.
*Some pain at the site is expected, but should be mild, not severe.*
A patient can have a rebleed (the insertion site opens and starts bleeding), evidenced by pulsatile bleeding, not a steady stream. It looks really scary, and the patient CAN bleed to death if not caught, but is easily managed. Hold pressure above the site (2-3cm), and manage B/P as above until bleeding stops. Call for assistance, do not leave patient. Notify your MD. I usually get an order for extended bedrest no matter what closure device was used, because of the patients increased risk.
A vasovagal response to pressure on the femoral artery is evidenced by nausea, bradycardia, and hypotension. This can happen with a hematoma. Treat with Atropine 0.6mg IVP, IV fluids, and trendelenburg. Obviously call your Doc for further orders.
The worst post cath complication is the hardest to diagnose unless you know about it: that is a retroperitoneal bleed. This is BAD! The patient is bleeding into their abdomen and you may not see bruising, etc. It is caused by the catheter piercing the artery at any point in the body, not just at the insertion site.
The patient will have vague complaints of abdominal or lower back pain.
There will be sudden signs of shock (hypotension, tachycardia, diaphoresis, pale skin, possibly nausea, anxiety).
Hold pressure 2-3 cm above the site as always.
Check B/P every 5 minutes.
Start fluids wide open.
Notify your Doc STAT! This is a MAJOR emergency! If your hospital has a medical response team for emergencies activate it for further assistance in treatment.
Also it is not normal for the limb to be cold without palpable pulses. Both limbs should be equal in pulse strength, and temp (unless there is another disease process, in which case they should feel the same as they did pre cath). Is is also not uncommon for a patient who has had a stent placed to feel some chest pain after the cath. This is caused by cardiac tissue reperfusion (similar to when your foot falls asleep, then starts to wake up again). Post cath chest pain should, however never be assumed to be normal, because it can also be a sign that the stent has clotted, which is an emergent situation. Other side effects of this are diaphoresis, and hemodynamic instability (high B/P), and chest pain that increases. If it is normal reperfusion the chest pain will stay the same and resolve itself over the next 12 or so hours. Either way tell your MD.
Lastly to answer your last question:
Stenting is when a device is used to open up a blocked coronary artery. This is known as percutaneous intervention. An angioseal is a closure device used to close the insertion site where the cardiac catheter is inserted. Most of the time it is a femoral artery, but sometimes they use the brachial artery in the arm. So, you can have a post angiocath without a stent, and you can have a stent with a different closure than an angioseal.
I hope this helps.