CCU - Removal of Femoral Sheath by Registered Nurses

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    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.

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    We pull femoral sheaths where I work. The policy varies as far as the way in which you pull the line. Manual, Compressar, and Femostops are what we use. On our standing orders there are paramaters that have to be met in order to pull the lines. First anti-coagulants must be off. The ACT must be less than 170 seconds. The SBP must be less than 150mmHg. The patient must be pain free and adequately sedated as necessary. If you need more info on line pulls don't hesitate to ask!
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    Nurses in the CCU pull shealths at my institution. ACT must be less than 170 and all anticoagulants must be off with the exception of Reopro on our PTCA patients.
    Nurses use manual pressure for 20 minutes. Femstops are not part of our protocol for RNs and require MD involvement.
    We do not use sedation in femoral shealth removal. I am curious what medications are commonly used and what is the criteria for medicating patients prior to femoral sheath removal.


    [This message has been edited by scott (edited 08-14-98).]
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    <<We do not use sedation in femoral shealth removal. I am curious what medications are commonly used and what is the criteria for medicating patients prior to femoral sheath removal.>>

    Our protocol is to use 25 to 50mg Meperidine IVP prior to sheath removal. The rationale is to promote relaxation for the patient and prevent vagaling down.

    I'm curious about something else.. at our facility we flush sheaths with NS after drawing ACTs.. a friend at another institution uses heparin to prevent small clots forming on the end of the sheath that could be dislodged with removal.. what do y'all do? and is there research on it? (I know I know.. I'll probably end up going to the library!! <grin&gt
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    At our institution we have standing orders for morphine 2-5 mg or Valium 5-10mg for sheath pulls.

    After we draw ACT levels we do not flush the line unless it is connected to a fast flush device with pressure bag. Sometimes our patients come back with lines in that are capped off in anticipation for quick removal.

    The theory behind not flushing after drawing is to prevent the flushing in of any clot formation at the tip of the sheath. I don't have any research info. readily available at this time.


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    In my institution (400+ bed), nurses in the Seated Recovery, CCU and PCU (cardiac step-down unit) are certified to pull sheaths. We wait until the ACT is below 160. Our patients remain on Reopro, and we will start to use Aggrastat soon. We use manaul pressure, Compressar, or the Fem-Stops. Using the C-Clamp seems to be the easiest. we usaully premedicate the patients with MSO4 and Phenergan. We waste 10 cc from each sheath (arterial and venous), to make sure there are no clots
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    I work in a very busy ccu. We use femostop and C-clamps during sheath removal. Our protocols dont require doctor intervention for femostop removal bp is monintored proir to sheath removal on a comonsense basis ie is the patient hemodynamicaly stable at the time and asympytomatic we must have atropine the and epi in the room prior to sheath removal. we also require two RN's to be present during removal in case the unthinkable happens the ACT must be less than 150 some doctors write for less than 160 the femostop is place above and medial to the insertion site for removal of arterial lines and just below on venous sites the inflate the femstop till occlusion of the artery occurs as related by dopplered pulse once you determine the pressure at which the vessel will occlud you the pull the sheth out while inflating the femotop to the pressure reached before or until no bleeding is observed from site that part is a little dicy while doing all this keep a close eye on pt hr via monitor (BRADYCARDIA) hold at this pressure for Aprox 1-2 min the slowly deflate by 10mmHG every 5-6 minutes until pressure of 40mmHG the leave in place for six hrs after the sheath was first pulled. After six hrs carefully deflate femostop and check for any possible beeding the place a pressure drsg in struct pt to keep leg straigt during entire proccedure and for a couple of hrs post procedure.
    Any questions pleas feel free to contact me.
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    my new email address is in my profile.
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    Our hospital uses both femostops and compressors, the floors and icus use femostops and the cathlab holding area uses compressors, both femoral and radial.We (cath lab ) hold manual on brachial sites and on patients to large for devices (300+ lbs). Femostop protocol is 20mmHg above sbp for 20 minutes then reducing the pressure by 20mmHg every 10 minutes until the gauge is at 30mmhg. Then it is left on for 3 hours. 2 RNs at bedside for the first 10 minutes with the patient on hardwire with bp q 5" for the first 1/2 hour. We have epi and atropine at bedside and the pt must have a running iv.
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    Where I used to work, RN's always pulled sheaths(arterial and venous). The usual orders were to wait until the ACT was <150, no anti-coagulants (Reopro is ok), pre-medicate with MS04. We always used 2 RN's for the first 10 - 15 mins. in case of complications. We used manual compression, we had a Femostop on the unit, but most everyone felt more comfortable with manual compression. I felt like I had more control over what I was doing.


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