vasovagal post sheath removal

  1. 2 How long after sheath removal can a vasovagal response occur?

    Situation: I picked up a stable patient post exploratory neuro angio (no cardiac history). This patient had walked into the hospital for the angio, pre-elective surgery for aneurysm clipping the following day. She had gone straight to angio/cath lab on admission. When I went to retrieve her, the sheath had already been pulled (sheaths are not pulled in my unit), the patient was reported as stable, and had already been transferred to a stretcher. I hooked up my travel monitor, BP and HR were normal, assessed the site and noted no hematoma or excessive bleeding to the bandage, also a strong pedal pulse.
    Once I was in the elevator, the patient reported feeling "funny". Never what you want to hear in the elevator. In the second I spent assessing the site, I watched her HR plummet into the low 30s, quickly followed by a dropping blood pressure, and decreased LOC as I prepared a dose of Atropine. With the Atropine and the initiation of a ns fluid bolus, she was rebounding as we made it back to the unit. Note: there was no change to the site and the patient was flat in bed.
    Finally, to my question....
    I have not trained for sheath removal, however, it was my understanding that the vasovagal response is caused by pressure and site pain during removal. So why did this occur 15 minutes after pressure held and dressing applied in a pt with no complaint of site pain??? I checked the cath report and did not note any previous incident or Atropine administration while in the lab.
    How long following removal should one be concerned for this?
    Thank you for reading my very lengthy story!
    Last edit by vic_rn on Nov 29, '11
  2. Visit  vic_rn profile page

    About vic_rn

    Joined Nov '11; Posts: 17; Likes: 12.

    6 Comments so far...

  3. Visit  aCRNAhopeful profile page
    0
    Hmm good question. I couldn't exactly say WHY it would happen that way without pressure, bleeding, or pt movement. I'm not too familiar with the intervention they did in the lab but could that have something to do with the cause?
  4. Visit  Biffbradford profile page
    0
    Since the vasovagal response is neural, travels FAST, then maybe it was something else that caused the drop in heart rate. Unusual for sure!

    WHat was her baseline HR?
  5. Visit  BelgianRN profile page
    0
    It could just as well have been a vasovagal collaps that occured independently from her sheath removal. Was she prone to vasovagal reactions in everyday life? As posted above it is a neurological reaction so there is no logical explanation why the sheath removal caused this 15 minutes afterwards.
  6. Visit  fiveofpeep profile page
    2
    No idea. But good job avoiding a code in an elevator
    hockeynpolo and BelgianRN like this.
  7. Visit  Ivanna_Nurse profile page
    1
    Quote from fiveofpeep
    No idea. But good job avoiding a code in an elevator
    . Lol I was going to say the same thing!
    fiveofpeep likes this.
  8. Visit  TeleRN26 profile page
    0
    Quote from vic_rn
    How long after sheath removal can a vasovagal response occur?

    Situation: I picked up a stable patient post exploratory neuro angio (no cardiac history). This patient had walked into the hospital for the angio, pre-elective surgery for aneurysm clipping the following day. She had gone straight to angio/cath lab on admission. When I went to retrieve her, the sheath had already been pulled (sheaths are not pulled in my unit), the patient was reported as stable, and had already been transferred to a stretcher. I hooked up my travel monitor, BP and HR were normal, assessed the site and noted no hematoma or excessive bleeding to the bandage, also a strong pedal pulse.
    Once I was in the elevator, the patient reported feeling "funny". Never what you want to hear in the elevator. In the second I spent assessing the site, I watched her HR plummet into the low 30s, quickly followed by a dropping blood pressure, and decreased LOC as I prepared a dose of Atropine. With the Atropine and the initiation of a ns fluid bolus, she was rebounding as we made it back to the unit. Note: there was no change to the site and the patient was flat in bed.
    Finally, to my question....
    I have not trained for sheath removal, however, it was my understanding that the vasovagal response is caused by pressure and site pain during removal. So why did this occur 15 minutes after pressure held and dressing applied in a pt with no complaint of site pain??? I checked the cath report and did not note any previous incident or Atropine administration while in the lab.
    How long following removal should one be concerned for this?
    Thank you for reading my very lengthy story!
    The vagus nerve runs near the sheath removal site. When you hold pressure on the sheath site you may stimulate the vagus nerve ad illicit a vasovagal response.


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