CCU - Removal of Femoral Sheath by Registered Nurses - page 2

by CWhite

60,805 Views | 42 Comments

Policy and Procedures of Femoral Sheath Removals by Registered Nurses. If you have any information on these topics please let me know? I need to benchmark , and set up some standards for our hospital cardiac services.... Read More


  1. 0
    I would like to thank everyone for their replies to my topic. they have been most helpful and I appreciate it immensley.
    Cheryl White
  2. 0
    Quote from CWhite
    Policy and Procedures of Femoral Sheath Removals by Registered Nurses. If you have any information on these topics please let me know? I need to benchmark , and set up some standards for our hospital cardiac services.
    hi c white,
    I have been working on a cardiology ward for 6 months and am ready to begin my sheath removal competancy but have found it difficult to find more than a handful of articles reguarding this skill. Those i have found have been rather contradictory. Is there any research based information out there which would be useful to me?
    J Thomas
  3. 0
    at my institution , we are certified to pull sheaths mannually .ACT must be less than 160 and all anticoagulants must be off except aggrastat on our PTCA patients.
  4. 0
    We pull sheaths in the unit after cardiac intervention. If the intervention was planned and the patient has not had an MI, they can be pulled in our stepdown unit and they have their own protocol (which is similar to but different than ours...)

    Our patients ususally come back with a 6 or 8 french sheath in place.
    OUr patients usually have aggrastat, reopro, or angiomax.
    If the patient is on aggrastat or reopro (usually for 12 hours) we check a CBC 2 hours after the drip initiation and check an ACT 4 hours after the patient returns to the unit. We can pull the line if the ACT is < 150.
    If the patient had angiomax without heparin and their creatinine is < 2 we check an ACT 2 hours after return to the unit and can pull the line if the ACT is < 175. If ACT remain high for a check or two we can check a PTT and pull the line if the the PTT is under a certain number that I can't remember right now (I've never had to check one...)
    IF the patient had heparin as well as angiomax or their creatinine is > 2 we wait four hours to check the act.

    Once the ACT is met, we usually sedate the patient with 2-4 mg of ms and 1-2 mg of versed (and can usually repeat x 1 if necessary). Our patient remain on CL diets while the sheath is in place until after the line is out and they can elevate their heads. We use a femostop for compression. I typically leave the femstop on for 45-90 minutes (I usually shoot for as little time as possible). We use a 10# sandbag for about 3-4 hours hours after the line is out. Typically, the patient is on bedrest for 6 hours after the line is pulled assuming there is no rebleed or hematome issues.
    If we have an A and V line we pull the A line first and the V line at least 30 minutes later...

    We do VS and groin checks
    Q15min x 4, Q30 x4, then 1 while the sheath is in place.
    While the femstop is on we are usually in the room while coming down to a pressure of 40-60 mmhg with the femstop but our policy states Q15min x 4.
    Once the sandbag is placed, I do Q15 x 4 again. However, I think our policy reads Q 15min x4, Q 30 x 4, then Q1 x 3 or 4, then Q2 and PRN.
    Pt can get OOB 6 hours after sheath pulled assuming there was adequate hemostasis without bleeds/hematomas etc.
  5. 0
    at my hospital ony the fellows, cath lab rns and a "sheath tech" pull sheaths. interventional pt's have integrillin, aggrastat, or reopro running. act has to be 180 or less. usually manual compression is used, but a few people favor the c clamps. usually we only use those if a groin blows and manual control is not possible d/t pt size, etc. if we need pain contol, we usually use fentanyl. policy is pt's rn at bedside 1st 5-10 min of sheath pull with fluids and atropine ready and continuous centrally monitored tele, bp o2 sat. i think having a team of rn's certified to pull sheaths is a great idea. the cath lab at my facility is VERY busy- sometimes 30 something cases a day (not counting middle of the night emergent ones) and pt's sometimes have to wait hours after the act is ready for a fellow to be free from case to come pull the sheath.
  6. 1
    Intersting stuff... now time for a dumb question if you all don't mind.

    What exactly would meke sheath removal painful? And how do cath lab sheaths differ from ablation sheaths?

    I ask because I am scheduled for cardiac ablation soon. While I have read all the info online about the procedure, as well as the brochure that was sent to me, obviously they don't get into the finer details as to what meds are usually given, etc. Sheath removal was not explained, either, so I was rather surprised to read here that one might be given mso4 and/or versed to remove the femoral caths.

    I was told I may well be able to go home that same day.. but with the procedure scheduled at eleven am, and it taking anywhere from 4-6 hours, then the waiting for ACT to come down and all the other stipulations.. and advocated bedrest/lying flat for several hours, I wonder how this will be possible... and it will be a five hour drive home. hmmmmmmmm.... ?

    Any tips ? I'd like to know a bit more of just what to expect medication and porcedure wise.. the stuff they don't usually tell on a website.

    Apprecaite it !
    sonshar likes this.
  7. 0
    Quote from jnette
    Intersting stuff... now time for a dumb question if you all don't mind.

    What exactly would meke sheath removal painful? And how do cath lab sheaths differ from ablation sheaths?

    I ask because I am scheduled for cardiac ablation soon. While I have read all the info online about the procedure, as well as the brochure that was sent to me, obviously they don't get into the finer details as to what meds are usually given, etc. Sheath removal was not explained, either, so I was rather surprised to read here that one might be given mso4 and/or versed to remove the femoral caths.

    I was told I may well be able to go home that same day.. but with the procedure scheduled at eleven am, and it taking anywhere from 4-6 hours, then the waiting for ACT to come down and all the other stipulations.. and advocated bedrest/lying flat for several hours, I wonder how this will be possible... and it will be a five hour drive home. hmmmmmmmm.... ?

    Any tips ? I'd like to know a bit more of just what to expect medication and porcedure wise.. the stuff they don't usually tell on a website.

    Apprecaite it !

    with an ablation they usually only do venous sticks (as opposed to art sticks for c.cath), so the bedrest after sheath removal will only be 2-4 hours instead of 6 (at my hospital). yeah ep studies take a long time. 4-6 hours is reasonable to expect. it is possible that you may be allowed to go home that day, do you have someone to drive you? it is really not safe to drive yourself after this procedure as you may be tired/a little loopy from pain meds and you will have to avoid heavy lifting for 1 week (or 2 as you MD rec's) after to prevent the chance of bleeding at the groin site. don't worry, you should still be able to walk around, go up and down stairs- just no heavy exercise or lifting for a week.
    not everyone's sheath removal is so painful. the part that hurts people is that someone is applying rather hard pressure in a sensitive place. if you are a pretty tough cookie and not prone to vagals, it should be no problem for you.
    ask the holding area RN's and your MD all of your questions before they start anything, and if possible have someone come with you to drive and to be a second set of ears. good luck.
  8. 0
    Quote from Pill Hoarding Hussy
    with an ablation they usually only do venous sticks (as opposed to art sticks for c.cath), so the bedrest after sheath removal will only be 2-4 hours instead of 6 (at my hospital). yeah ep studies take a long time. 4-6 hours is reasonable to expect. it is possible that you may be allowed to go home that day, do you have someone to drive you? it is really not safe to drive yourself after this procedure as you may be tired/a little loopy from pain meds and you will have to avoid heavy lifting for 1 week (or 2 as you MD rec's) after to prevent the chance of bleeding at the groin site. don't worry, you should still be able to walk around, go up and down stairs- just no heavy exercise or lifting for a week.
    not everyone's sheath removal is so painful. the part that hurts people is that someone is applying rather hard pressure in a sensitive place. if you are a pretty tough cookie and not prone to vagals, it should be no problem for you.
    ask the holding area RN's and your MD all of your questions before they start anything, and if possible have someone come with you to drive and to be a second set of ears. good luck.
    Well of COURSE ! I hadn't thought of that.. being venous sticks, they wouldn't take nearly as long as arterial sticks as the pressure isn't as great. I should have known that, I'm a dialysis nurse ! DUH !!! :chuckle

    Yes, dh is coming along so he will be driving.. we may even just stay the night there at a motel and head back the next morning. As it is, we're going up the night before, so we can find our way around at this huge medical complex. Have never been to UVA, so want to be sure we find everything ok.

    The brochure they sent did say no driving for one week after the procedure.. thought that was interesting. Afraid the sites might pop loose while driving and cause an accident perhaps?

    And, yes.. no heavy lifting. Guess I'll be pretty much useless at work then.. heh. Maybe they'll let me answer the phones and do some filing...
  9. 0
    Arterial sheath removal in our hospital is a competency. I've been pulling sheaths for 19 years and we do it differently now than way back then. I'm most comfortable premedicating with MS 2-4mg and about 200-500cc NS IV bolus, if the pt can tolerate the fluid. Also, in our CICU, we re-anesthetize the groin with 1-2% lido (also a competency). We hold manual pressure above the insertion site for 10 mins (without peeking!) and that usually does it. ACT must be less than 150 and BP around 120-130 syst. But tell ya what--those PerClose are wonderful!!
  10. 0
    hi
    i advise you all to read this interesting article:
    vascular complications after percutaneous coronary interventions following hemostasis with manual compression versus arteriotomy closure devices article
    journal of the american college of cardiology, volume 38, issue 3, september 2001, pages 638-641
    george dangas, roxana mehran, spyros kokolis, dmitriy feldman, lowell f. satler, augusto d. pichard, kenneth m. kent, alexandra j. lansky, gregg w. stone and martin b. leon

    Quote from cherip.
    arterial sheath removal in our hospital is a competency. i've been pulling sheaths for 19 years and we do it differently now than way back then. i'm most comfortable premedicating with ms 2-4mg and about 200-500cc ns iv bolus, if the pt can tolerate the fluid. also, in our cicu, we re-anesthetize the groin with 1-2% lido (also a competency). we hold manual pressure above the insertion site for 10 mins (without peeking!) and that usually does it. act must be less than 150 and bp around 120-130 syst. but tell ya what--those perclose are wonderful!!


Top