[MRMCcathhold]

Help! I work in a 26 bed cardiac/PTCA holding area. We provide pre and post care to caths, PTCA, stents, invasive and non-invasive cardiac and vascular procedures(ie various angiograms, Fistula declots TEE's,EP studies, Ablations). We also pull all the
sheaths. Cath lab may use a Perclose or Vasoseal. We may
sometimes admit emergency PTCA/Stent pts. with fresh MI's which may or may not be on IABPs.
We are being told that our staff to pt ratio is 5:1. That may change only if the pt is on a balloon pump. The manager is using a PACU standard involving conscious sedation to support her reasoning. Does such a standard exist for the Cardiac Holding area? We need your help! Our staff is suffering because we also do not have equipment to help with our q15" vitals despite frequent pleas for such equipement. The patients are suffering because we can't be in 5 places at once. Right now all we can do is file safety grievences until we can get this standard in writing.

[kyti]

I am a PACU CPAN. We pull all sheaths for our cath lab in addition to our regular surgical case load. There is no such thing as ASPAN stardard staffing for concious sedation, only ASPAN standards for staffing in the PACU. If you PM me a number to fax, I can fax you these standards. When we pull sheaths we use manual pressure with chito-seal ( take approx 10 min.) pt is basicaly 1:1 for about 20 min then inculded in our standards as an awake stable pt. Hope this helps

[Dinith88]

cathhold, at my place of employment we have a unit similar to the one you're describing. The only difference is the whole IABP thing...we dont send balloon pumps to our 'holding area'...they go right to CCU/ICU. The nurses who work our out-patient/CV holding area usually have 2-3 post angios/sheaths at a time...rarely 5. Sounds like you guys are knee-deep in groin checks and vital signs!

Does your unit close at night(ours does), or are you open 24/7?

[MRMCcathhold]

Originally Posted by Dinith88

cathhold, at my place of employment we have a unit similar to the one you're describing. The only difference is the whole IABP thing...we dont send balloon pumps to our 'holding area'...they go right to CCU/ICU. The nurses who work our out-patient/CV holding area usually have 2-3 post angios/sheaths at a time...rarely 5. Sounds like you guys are knee-deep in groin checks and vital signs!

Does your unit close at night(ours does), or are you open 24/7?

Hi Dinith88. Yes we are open 24/7 until 2nd shift Friday night or the night before the holiday's. 2nd shift either DC's the pts or they are admitted to an inhouse telemetry bed. At one time the IABP's did go to CCU however our CABG pts take priority over their beds therefore our manager feels is ok for us to keep the IABP until a CCU bed opens up. Very dangerous from our point of view when we only have a pump every 2-3 months and not long enough to really get comfortable with them.

[MRMCcathhold]

Hi Kyti Thanks for the info. The standard you speak of is one I'm familiar with. What I'm looking for is one specific to cardiac holding pts/post cath lab pts which require sheath removal. I wouldn't trust the fax you would send to get to me and not into my managers hands.

[sharann]

YOu have a dangerous situation there. If you have a pt who is going to ICU/CCU then you must staff as well as they do for that pt. So if you have a 1:1 in CCU, then you should not go below that standard of care. All out post intervention pts go direct to CCU (rather than our PACU where I work) and your manager is allowing you unsafe practices. If you cannot monitor EVERY patient d/t equipment shortage, then you a FULL. We have capability to monitor continuously for 10 pts. It they call to bring an 11th we say sorry we are at capacity now, you hold them. What happened to common sense (I'm not speaking of you cathhold)