Originally Posted by basel

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

any chance of a link?

Originally Posted by basel

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

I read a summary of the abstract. Wow! We have pretty good luck with the devices, but it has a lot to do with the skill of the cardiologist, I think. And how many times the Doc had to stick the groin to access the artery.

Originally Posted by 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.

Contact your local Angiomax rep. They gave our institution a CD on proper technique of sheath removal and manual pressure. The RN's in our CCU pulled all the shealths that came back to us. It is a great resource.

Originally Posted by MonTif

Contact your local Angiomax rep. They gave our institution a CD on proper technique of sheath removal and manual pressure. The RN's in our CCU pulled all the shealths that came back to us. It is a great resource.

How does the RN in CCU pull your sheaths we she/he has their own patients??? Or, are they only sheath pullers without other duties. In our hospital a few trained telemetry nurses do this, NOT, ICU nurses.

[quote=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?

QUOTE]


Another thing that make the sheath pulling painful is if there is already a hematoma present. When you place them on a C-clamp with a big ol hematoma, it is quite painful. We use morphine, and we allow the tech to pull them if they have passed a course and the RN must be in the room. They will also hold the pressure if it is manual pressure bing applied.

Hi
I an am RN in the UK and work in a cath lab.
I have just read through the was things are done in the US and am amazed.

For cardiac cath we use 4,5,6 fr check flow depending on DR

Femostops are used by all RNs once they have been taught
No IV fluids or sedation

Femstop off within 20 mins, bedrest afteer this
4fr 1 hour
5fr 2 hours
6 fr 2 1/2 hours
Out of bed walk to toilet and home. We have the odd brady one or two a week IV fluids usually does the trick.

All pataint are given after care advice and asked to rest up for 24 hours and have an adult with them overnight in case of bleeding

We do not give heparin for our angois only PCI and these patients all have angioseal an internal collegen plug.

It been great to read how it is done in the US.

Howdy, I figured I'd throw my 2 pennies in here too.

I pulled my first sheath way back in Jan. 1996, and have pulled somewhere around 2000 or so since. I have seen a variety of hemostasis devices and still prefer the first I ever used which is the fingers I am typing with. I have yet to have a vasovagal (sudden drop in BP and HR, related to increase in vagal tone) while providing manual pressure. I also use c-clamps w/ Compressor discs, but really when I have time prefer the manual technique. Having performed many pulls in my 9.5yrs. of nursing, I started using a procedure about 7 yrs. ago where I would infiltrate an oozing site with lidocaine 1-2% with Epi 1:100,000 to shore up any small vessel bleeding. The technique worked quite well, resulting in a more comfortable patient and achieved hemostasis from the localized vasoconstriction. About 2yrs. ago, I authored my hospital's "Lido w/ Epi injection Policy." After getting several "ignorant" doctors on board and explaining to them how the procedure worked, and getting pharmacy approval, and getting approval of the hospital medical board, we finally got them on our Post Intervention orders last fall. If any of you guys are interested, PM me and I will forward you a copy of the policy. I have a friend and former co-worker who left my facility and took this procedure to another facility and they are currently working on a similar such protocol. This injection works wonders esp. with Perclose or Angioseal sites that have the never ending ooze. This WILL NOT be effective on an arterial bleed, but does quite well with moderate oozing sites.

Doug

sheaths

act<180 with patient's condition stable, we take out our own sheaths, though some nurses the newer one's call the fellow to take it out, though sometimes cv fellows are so busy in the er with new consults that rn's take out both venous and arterial sheaths using femstop, though i have one cardiologist who i try to beat first before he comes because he hates femstops and he manually compresses for ten minutes then tend to leave a nurse to manually compress for another twenty, i mean really i dont mind it but my fingers hurt when i do that, so femstop's the way to go, if they're not wiggly u could just sit right there and chart and watch the wound at the same time

Originally Posted by SEOBowhntr

Howdy, I figured I'd throw my 2 pennies in here too.

I pulled my first sheath way back in Jan. 1996, and have pulled somewhere around 2000 or so since. I have seen a variety of hemostasis devices and still prefer the first I ever used which is the fingers I am typing with. I have yet to have a vasovagal (sudden drop in BP and HR, related to increase in vagal tone) while providing manual pressure. I also use c-clamps w/ Compressor discs, but really when I have time prefer the manual technique. Having performed many pulls in my 9.5yrs. of nursing, I started using a procedure about 7 yrs. ago where I would infiltrate an oozing site with lidocaine 1-2% with Epi 1:100,000 to shore up any small vessel bleeding. The technique worked quite well, resulting in a more comfortable patient and achieved hemostasis from the localized vasoconstriction. About 2yrs. ago, I authored my hospital's "Lido w/ Epi injection Policy." After getting several "ignorant" doctors on board and explaining to them how the procedure worked, and getting pharmacy approval, and getting approval of the hospital medical board, we finally got them on our Post Intervention orders last fall. If any of you guys are interested, PM me and I will forward you a copy of the policy. I have a friend and former co-worker who left my facility and took this procedure to another facility and they are currently working on a similar such protocol. This injection works wonders esp. with Perclose or Angioseal sites that have the never ending ooze. This WILL NOT be effective on an arterial bleed, but does quite well with moderate oozing sites.

Doug

I agree that the good ol' fashion way of holding pressure (my hands) gives me a better idea of how the site is doing after the sheath is removed, i.e. I can FEEL the hematoma underneath my hands rather than have to guess with the clamp. Collagen plugs can't be used on all patients--weird anatomy such as a bifurcation of the vessel makes them useless. Instilling lido before sheath removal is part of our competencies, but no epi. Epi in a heart patient?? Not here. But about 10cc of subq lido and wait a good 10 mins. and there is usually no problem. Plus about 2mg of MS IV and a 5 mg po Valium and they sleep through the whole thing!

Originally Posted by JustMe

I agree that the good ol' fashion way of holding pressure (my hands) gives me a better idea of how the site is doing after the sheath is removed, i.e. I can FEEL the hematoma underneath my hands rather than have to guess with the clamp. Collagen plugs can't be used on all patients--weird anatomy such as a bifurcation of the vessel makes them useless. Instilling lido before sheath removal is part of our competencies, but no epi. Epi in a heart patient?? Not here. But about 10cc of subq lido and wait a good 10 mins. and there is usually no problem. Plus about 2mg of MS IV and a 5 mg po Valium and they sleep through the whole thing!

Just me,
The Lidocaine w/ Epinephrine is injected SQ/IM to create a localized vasoconstriction, it is not IV, and has no effect on HR or BP. The Epinephrine does two great things, it shores up the oozing, and makes the Lidocaine last a lot longer, because it decreases the rate it is metabolized when it vasoconstricts the local area. I don't use this technique to "numb" the site up, I use it to stop the bleeding, the numbing effect is just a bonus. This is the same trick you see ER doc's use when they suture up a messy cut, the Lido w/ Epi gives them a "clean" area to work in so they can see what they are doing a little better. Also a trick used in anesthesia for nerve blocks, spinal, etc.

Doug