Originally Posted by SEOBowhntr

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

Yeah, I know what the epi is added for, but there could still be systemic effect from it. Ever notice your heart pounding when the dentist gives you novocaine? I asked my dentist and he admitted that there's epi in it (besides the fact that you just got shot in the mouth ). Is there any research even out there about using Lido alone or Lido with epi? I read one study that claimed you only need the IV MS for patient comfort while pulling sheaths. I've found that the Lido (plus allowing enough time for proper numbing) is more than adequate for patient comfort. Most of their complaints are back pain from having to lay flat.

Using the C-Clamp seems to be the easiest. we usaully premedicate the patients with MSO4 and Phenergan.

Do you stay WITH the patient while the C clamp is on at all times. How far in advance is the medication given prior to removal???

Re: Removal of Femoral Sheath by Registered Nurses

I'm a newbie, so please be gentle! What is the difference between a femoral sheath and femoral line? Thought the sheath was an anatomical entity NOT to be removed. Or is the reference to removing a femoral sheath, actually the removal of the plastic sheath of the cannula in the femoral vein?

Something to do w/ IABP?

Isn't a femoral line, a central one; though not to be relied on for PCWP

Isn'a a femoral sheath, part of a patient's anatomy?

I'm stumped and need this info; can someone explain in BABY TERMS and gently?

Thanks in advance and where can I go for procedure? It's kind of obvious I don't work in ICU, but am intrigued. Can someone help out a fellow RN?

team

Re: Removal of Femoral Sheath by Registered Nurses

hi iam new how can particepeat with you

Re: Removal of Femoral Sheath by Registered Nurses

Hello, haitham abo majed,

You are participating everytime you make a response to a thread. We are glad to have you.

Do you have a question/comment?

Re: Removal of Femoral Sheath by Registered Nurses

A femoral line usually refers to an arterial line placed in the femoral artery. You can have arterial lines in other places, radial, brachial, axillary, etc. These are very small lines, just a little bigger than an IV. Femoral Sheaths are used in the cath lab. The sheaths come in different sizes, but are much bigger than an IV. Sheaths are also placed in the artery. So the sheath is actually the plastic that is placed into the artery by the MD. He uses this sheath to feed the catheters to place stents, etc. Sheaths can also be placed into veins as well. The previous posts were referring to devices that can be used to hold pressure on the artery after pulling the sheath. There are many different kinds, manual pressure, C-clamp, Femo-stop,etc. And some procedures that the physician can do, like Perclose, that helps with hemostasis.

Re: Removal of Femoral Sheath by Registered Nurses

Hello,
Well, usually during the procedure you are given a concious sedation(Diamorphine, Midazolam), it does take the edge of and it is tried to keep the patient as comfortable as possible. Some patients are more sensitive than others but you are allowed to tell the staff if you are uncomfortable, well that may not even be needed as the staff present is supposed to be monitoring you closely and any sign of discomfort from you is mentioned to the Consultant and a bit more of the 'Happy stuff' is given.
Well the sheath removal is done right in the lab obviously it depends on the type of ablation you are having or if because you had heparin and the ACT is above 150 seconds then the sheath is removed later on the ward once the ACT is about 150seconds.
In the first instance the nurse warns you when taking the sheath off and then pulls the sheath out during which it might sting or you feel a little pain after that manual pressure is applied on yout groin by the nurse and except for the pressure you must not really feel any discomfort.
However when the sheath is taken out later onthe ward by then the effect of the local anaesthetic wears of and so you may be given a bit of morphine before the removal of the sheath to avoid much pain and discomfort.
I am sure you will be fine.
I am a senior cath lab nurse.........I really do care for my patients and like keeping them as comfortable as possible.
Sonia

Re: Removal of Femoral Sheath by Registered Nurses

Literature Review
Add Added
Arterial puncture site management after percutaneous transluminal procedures using a hemostatic wound dressing (Clo-Sur P.A.D.) versus conventional manual compression: a randomized controlled trial. (includes abstract); Mlekusch W; Dick P; Haumer M; Sabeti S; Minar E; Schillinger M Journal of Endovascular Therapy, 2006 Feb; 13 (1): 23-31
Add Added Bed-rest post-femoral arterial sheath removal– What is safe practice? A clinical audit. By: Tagney, Jenny; Lackie, Dawna. Nursing in Critical Care, Jul/Aug2005, Vol. 10 Issue 4, p167-173
Add Added Comparison of the FemoStop device and manual pressure in reducing groin puncture site complications following coronary angioplasty and coronary stent placement. By: Walker, Sandra Beverley; Cleary, Sonja; Higgins, Monica. International Journal of Nursing Practice, Dec2001, Vol. 7 Issue 6, p366-375,

These are just a few I used for the policy I wrote. Also lippencott online is a good resource. ACT less than 165. 20 minute manual compression and groin sites only. no brachial or illiac sheaths removed by RN staff. Also we had a clause for coverage it the patient had received a thrombolytic in 24 hours the MD had to remove the line.

Re: Removal of Femoral Sheath by Registered Nurses

To D/C a sheath - we use manual, c-clamp, or femostop (which requires a MD order r/t cost)

We start checking the ACT within an hour after the patient arrives from the Cath Lab and usually pull when the ACT is less than 175 sec. We check the ACT hourly if > 175.

We premedicate with Demerol 25 mg w/ Phenergan 12.5 mg IVP or Versed 1mg with Morphine 2mg IVP.

Many times I start with the c-clamp or femstop, minor oozing/hematoma forms and i resort to manual pressure ... anyone else?

Re: CCU - Removal of Femoral Sheath by Registered Nurses

We Pull The Sheath If Act Is Less Than 150,in Terms Of Femostop Use ,we Need To Have Doctors Order.to Cover Ourselve.we Prefer Manual Pressure Unless Patient Has Big Body Built,with Hematoma Or Bleeding.