I like what Just me said; premedication and bolus with NS is a great idea. Sometimes explaing to the Pt if possilbe that your might be inflicting them with a moderate amount of discomfort can ease them into accepting some sedation. ie (versed/fentanyl) that being said, have had more successful pull when doing it myself, I have also seen people who pull get a little overzealous and not get control of the vessel; Then we go to a trendelenburg positon, atropine, NS wide open. plus we have to type and cross for the two-three units they need following a "nursing procedure". YIKES!
If you are prepared, get the pt and bed into a position that is comfortable for YOU; then you will be ready and "relaxed" when you pull. if you do things hastily then you might set yourself up for a disaster.
1, feel the pulse (femoral and distally) I mark the distal ones for yourself or another if your facility requires two for a pull.
2. cleanse area around with whatever your facility uses.
3. aspirate/don sterile gloves/O2, IV ready, emergency drugs available, set vitals for Q2-5 minutes/ locate femoral pulse site. (some of these are don simaltaneously) (spelling
I use the index finger, middle and ring finger of the hand closest to the patient; RIght groin use left hand.
I put thos fingers about two-three fingerbredths above the actual puncture site. Seeing how the artery is entered with the modified seldinger technique will help you understand that holding on the skin puncture site=retroperitoneal bleed.
if you have your hands in the right position; pull the sheath, observe a little bleed back and then apply enough pressure til the bleeding stops. With one hand you can hold the femoral artery until hemostasis; blot the puncture site with sterile 4x4s. plus you can monitor for hematomas with your free hand.
If you were proactive and cleansed the feet with "sterile" cleansing solution you can also palpate a distal pulse to monitor how much pressure you are applying (if you are solo during sheath pulls)
I hold pressure for about 20-30 minutes though have had to hold up to 55 minutes for Femoral grafts and the like...
Some things to think about
not fun pulling when 2b/3a inhibitors are infusing.
likewise with heparin therapy. stob both of them until hemostasis, then restart according to MD orders/ policies.
if your patient has back pain before the pull Medicate them.
Always be prepared!
your clients and family members will appreciate it
Hope that helps.