[lever5]

I have worked in hospitals across the nation, mostly in caradiac. The hospital I am working in places a ice bag and a weighted bag on the cath site during recovery. I am wondering why? They say the manufacturer of angioseal and others recomend this. Does anyone else see this practice?

[Medwynn]

I've only been working in the CCU for a month and with cardiac caths closed with perclose or angioseal. It's 4-6 hours straight legged and w/o ice or a sandbag on top. usually 4 hours. that sounds kind of odd to me but it may be standard practice somewhere else.

[jmgrn65]

nope never heard of it. How long is the ice on? Seems like it would be uncomfortable.

[ckc6977]

We just switched back to angioseal. It no intervention, pt is on BR for ~2H (max). No sandbags or ice. If increased risk of bleeding then we may increase BR or place a "Femstop" on pt.

[Spatialized]

Never seen this. We don't even use sandbags, weight distribution is too general. Plus, if they use a closure device, there shouldn't really be a need for pressure unless you have oozing. Then direct hand pressure is our floor's preferred alternative. If it's closed (angiosel/perclose) it's BR for 4, with HOB to <45 degrees. If we pull the sheath on the floor they're flat 4 hours after the femstop or clamp comes off. And if you add in Intergrilin or Angiomax et. al. bedrest is even longer - depending on the doc.

Cheers,
Tom

[dianah]

Haven't heard of the ice recommendation.
We routinely DON'T put sandbag or pressure dressing on the site.
Our Cardiologist's thinking is: no one may lift the sandbag up or peek under the dressing to assess for bleeding, so they'd rather leave Angioseal or perclose site with just a band-aid.
That way, if it bleeds, you know it!

Angioseal rep told us the pt could (theoretically) be up 20 min after the seal is placed.
We are more conservative, and keep the pt bedrest X2hr.
Check with the rep, as the rep recommended we elevate the HOB no more than 30 degrees (but that's better than FLAT for two hr!).

Now, after StarClose is deployed, we were instructed to have the pt give a big cough and to bend the affected leg up, to test the seal!
But then we still have the pt bedrest X 2hr, with the HOB elevated no more than 30 degrees.

Clo-Sur P.A.D. is bedrest X 3 hr, with HOB elevated same way.

Well, after all that, it seems each Lab's practice is driven partly by mfr recommendation, and partly by MD preference!
It's interesting to note the differences in practice in diff't Labs.

[harley007]

We use Angeoseals with 2 to 4 hours leg straight bedrest, HOB@ 30 degrees and instruct patient not to lift head - use electric bed instead and to put mild pressure on site with their hand for a hard laugh, cough or sneeze. Ice and sand bags on a seal sounds like using a belt and suspenders - only need one but just to be overly carefull ........ We have one MD that does something similar. He Angeoseals and then insists we drop everything and immediatly rip to the patient's side to apply a huge wedge dressing with a maximum tape job. It seems this is just a waste after the Angeoseal and it drives the nurses on the post floor crazy because they cannot see the site with that bulky wedge dressing and the tape everywhere. Usually we dress the site with a 4X4 folded up to postage stamp size on the site with a Tegaderm to cover. Put on the little green sticker from the Angeoseal insert and everyone is happy!

[al7139]

I work on a cardiac unit. If a cath patient has an intervention (stent, unblock, etc.) they stay in ICU or PCU for 24 hours. If they do not need an intervention, they come to us directly. The cath lab RNs pull the cath, then monitor for hemostasis before transporting to us. After that, the pt is usually on BR for 4-6 hrs and we check the dressing frequently. After the BR time is up, they can be up in a chair with us checking the dressing for bleeding. I have never heard of sandbagging or icepacks on a cath pt. The cath nurses pull the cath, and apply pressure for 20-30minutes before putting a dressing on the site. Most of the time,the pts never have a bleeding problem even after coming to us.
Amy

[neko11111]

I've never heard about the ice before, but what they are teaching in schools these days is that the sandbag is mostly just to remind the pt not to bend or lift their leg.