I am a RN working in a CCU in Saudi Arabia where they do things a little differently to say the least!
What is peoples expereince with working with angioseals? Good and bad experiences welcome. Also the unit where I worked in Australia never used pressure dressings post angiogram unless it was indicated. Pressure dressings are used currently where I work and my main complaint is that you can't tell what is happening under a thick bandage!
Any thoughts or suggestions
Apr 24, '03
The angioseals are nice, esp for the patients, they don't have to lie flat for as long as with the sheath still being in. However, the only time I had a patient withe an angioseal is if a) the coronary arteries were clear, or b) the arteries were so bad, the patient needs a CABG. So anyone who had interventions (stents etc) came back to the floor with the sheath still in for us to pull later.
And I agree with you on pressure dressings, I really wouldn't ever need for a pt to be bleeding out in the bed sans my knowledge!
Apr 24, '03
We always use pressure dressings...
I just apply the dressing in a way that the top I am able to pull back a little bit and peak during my assessments to make sure it looks okay. However, if the patient starts to bleed... you are gonna know.
Apr 24, '03
I'm not thrilled with pressure dressings usually either. Our Duett rep taught us a neat trick when appling them that makes the dressing smaller and easier to assess the groin.
While one person maintains pressure on the puncture site. Another person first folds two 4 x 4s in half and then in half again. Bring the leg out and bend the knee only very slightly(looks like a frog leg). Put the folded 4 x 4 over the puncture site. Taking 2 inch silk tape bring it up from the inner thigh across the 4 x 4 and over the hip. Then do the sam with a second peice of tape. When you straighten the leg it applies pressure to the puncture site. The dressing is small, so you can still assess the groin. I wish I couls show you, because it works so well.
We use Angioseals and Duetts. Both work well. We did have one angioseal that got stuck, it wouldn't deploy and it wouldn't retract so we could get it out. Had to get a vascular surgeon to fix it. The patient did OK. We seal out patients, in patients that would have problems lying flat and occassionally we do seal uncomplicated PTCAs/Stents.
Apr 28, '03
Although angioseals are nicer for the patients, we have had an issue with oozing and occassional hematoma formation, if i have a patient with an angioseal, i usually put a tight pressure dressing on it, keep a real close eye on it, and have the patient be still for as long as i can make them (within reason of course
) We dont use angioseals all that often, i think only one of our docs really uses them... usually the patient comes back with the art line still in...the nurses on the unit are still wary of the angioseal...but when they work right they are nice!
May 1, '03
Most of our docs like Femstops so we rarely will use any kind of pressure dressings at all... they like us to go directly to a transparent dressing after removing the Femstop, so we can catch any problem immediately.
We've been seeing very good results with the Angioseal...and patients like it too.
May 2, '03
I love angioseals, the patients that have been cathed with the old pressue dressing, love it too.
I have noticed an increase in oozing, requiring pressure being held again, then pressure dressing applied. Could also be that we're using more of them?
Either way, as zambezi stated, when the work right they are nice!
May 9, '03
I'm a cath lab nurse and let me say that I love the angioseal, particularly the new "springless" ones. Frankly, we've had fewer problems with the angioseals than with any of the other closure devices we've used. The key, (IMHO) is to keep them flat for one hour post-deployment. There have been some problems with patients who try to move too much earlier than that. We've even had a few deployed on patients who were post PTCA while they were still on IIB/IIIA drugs with no difficulty.
Jun 16, '03
I had a pt with an angioseal last week. It was great. The one we use is clear so it's not difficult to assess drainage. The pt lays flat for 4 hours post cath and then can elevate the HOB to 30. The patient took it off the next day in the shower. No problems. I liked it much better than the pressure dressing I had that had 3 inch foam tape. It was difficult to pull the tape far enough back to assess the site without removing pressure and it looked like the 4x4 would come loose if I investigated too much.
Jun 17, '03
IN OUR LAB WE APPLY DIGITAL/CLAMP PRESSURE FOR 15 MINS POST ANGIOGRAM AND PLACE A SMALL AMOUNT OF GAUZE OVER THE WOUND SITE. THE PATIENT HAS 4 HOURS BED REST AND THEN ABLE TO GET UP AND ABOUT. IF A PRESSURE DRESSING IS REQUIRED WE USE A 1 LITRE BAG OF SALINE ON THE GROIN FOR PRESSURE. WE AVOID USING PRESSURE DRESSING IN THE LAB AS IT PROVES DIFFICULT WHEN THE PATIENT RETURNS TO THE WARD YOU CAN NOT SEE WHAT IS GOING ON UNDER THE DRESSING. WE USED TO APPLY PRESSURE DRESSINGS TO ALL OUR PATIENTS MANY MANY YEARS AGO BUT IT HAS BECOME OLD PRACTISE
Aug 22, '03
We use angioseals for all cath procedures. I think it depends on the doctor who is using them. Sometimes there is a little oozing and we apply a five-pound sandbag. It is very rare that we see any profuse bleeding or hematomas. We love em and so do the patients at the VA.
Aug 28, '03
Our cardiologists have suddently changed their minds about Angioseal...seems there has been some migration and distal vascular occlusions with the stuff too many times. Our hospital is now in their infinite wisdom doing away with Femstops as they are 'too expensive" <sigh>
Now we're back to direct, time-consuming manual pressure. Of course this is what we did BEFORE the newfangled stuff. But nowadays we are not staffed for these 20-30 minute periods of time off the unit in one room. (Cathlab does NOT pull sheaths...staff nurses do in my facility)
The docs now want us to slap on a Syvek patch (seaweed based anti oozong action), after 20-30 " direct manual pressure, but it doesn't help with immediate hemostasis achievement. <sigh>.
Last edit by mattsmom81 on Aug 28, '03
Aug 28, '03
I am a previous EP lab nurse, but recently had to have a cath myself! it was interesting being on the other side of the table, but I had great care and since I work in a cardiology office, I chose the best operator we have and he did a wonderful job! And, my coronaries were HUGE and clear of disease so I was VERY happy. Anyway, I had an Angioseal,, and had only a small 4x4 folded in quarters and covered w/tape. I had bedrest for 3 hours (which I slept through, luckily) then got right up and went home. I had no bruising, no bleeding, no knots, no nothing at the site. I am fortunate!!
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