Quote from mpccrn
our hospital is just starting a cardiac cath program and i wrote most of the policies and procedures regarding it. After extensive research I found it recommended that highly trained limited personell (cath techs) be the only ones to pull sheaths. It was found that these people are the most trained and qualified people to do it and keep their competency current through repetition. I also wrote that the techs document the pulling in the progress notes. I saw no reason for the RN to play secretary for them.
I agree that only "highly-trained" personnel should be pulling sheaths, and cath lab techs (radiology techs and UAPs such as CVTs) generally have extensive experience in this arena. It is important to note, however, that an RN must be on hand during the sheath pull to monitor for complications such as vasovagal reactions. If I'm the only RN around, I am NOT the one pulling the sheath. My tech will pull while I monitor the patient. If I have a second (critical care/cath lab) RN, I get to pull the sheath.
I am quite experienced at pulling sheaths, which are mostly CFA (common femoral artery) access sites. My cath lab performs both cardiac and peripheral interventions, so it's not uncommon to see antegrade CFA access. These are a little trickier to pull, IMO. We do a ton of radial approaches here, but the MD always pulls these (whether diagnostic or interventional) at the end of the case, as we use a form of mechanical compression for radial access sites. We rarely use a brachial approach anymore, but I have pulled these sheaths, as well.
If a procedure was diagnostic only, heparin should not have been given during the case, which means that the sheath can be pulled right away. If anticoagulants were given and the MD is unable to use a closure device (Starcose, Perclose, Angio-Seal, Mynx, etc.), we generally wait until the ACT is less than 180 before pulling (unless Angiomax was used--it's a direct thrombin inhibitor that cannot be measured by ACT--the protocol is to pull the sheath 2 hours after Angiomax was dc'd).
Cath Lab digest is a free periodical that is an excellent resource for arterial sheath management, among other things cath lab-related.
Oh, and not that you asked, but I must throw in my
regarding the pulling of arterial and venous sheaths. ALWAYS pull the arterial sheath first and NEVER pull them at the same time!!!!!