I work in the Cath Lab and Angio; the Radiologists pull their own and hold their own pressure. In the Cath Lab, the "Cath Tech" (a specially trained respiratory therapist, in our facility) pulls and holds or assists with deployment of Vasoseal and holds pressure after deployment. Vasoseal is not deployed for every case, for various reasons. In the past two years we too experienced a lot of what you describe (not related to Vasoseal use, just with the old pull-the-line-and-hold-pressure X15min, affected leg still for 6 hr after case), and could only relate it to the increased use of Lovenox. We now require Lovenox to be held 12 hr before the cath (or angio), in order to minimize potential bleeding after the case. The problems with bleeding you've experienced may be related to other factors as well: Pts on ASA (which our Cardiologists don't want to dc for three days pre-Cath, for obvious reasons), any homeopathic meds the pt has been taking that prolong bleeding, use of Ticlid or Plavix that may increase bleeding . . . to name a few. IMHO, in the face of your recent events, a review of suspicious factors is in order, and, I agree with your Intensivist: the Cards put 'em in, they should take responsibility for pulling them and maintaining hemostasis (just my background!!
). However, I know how hard it is to change something like this ("This is the way we've ALWAYS done it)." Also, the way you've done it in the past has worked well till now, and that seems to move suspicion away from a technique problem to the "other factors" problem.
How are the lines handled at other facilities in your area? In your hospital is an ACT done pre-pull? Have you gone on-line to search similar problems?
In any case, again, a review of the whole picture is in order. This may be handled by the Medical Director before you get back to work, anyway, and our discussion may be a moot point. Would be interested to know what happens. Good luck, and good advocating. -- D