Venous/Arterial Caths

[jeepgirl, LPN, NP]

Ok. I was at clinical today, and a girl was talking about her patient. She said that the patient's femoral cath site had a hematoma, bleeding, ozzing, ect and that the doctor told the family that the reason it kept bleeding was because pressure had not been held in the right place (they asked why the nurse holding pressure did not work to stop the bleeding). So, for a venous site, do you hold below or above the site, and for arterial, do you hold above or below.

Thanks a bunch. I've been looking and haven't been able to find specifics yet.

[Surgical Hrt RN]

Ok. I was at clinical today, and a girl was talking about her patient. She said that the patient's femoral cath site had a hematoma, bleeding, ozzing, ect and that the doctor told the family that the reason it kept bleeding was because pressure had not been held in the right place (they asked why the nurse holding pressure did not work to stop the bleeding). So, for a venous site, do you hold below or above the site, and for arterial, do you hold above or below.

Thanks a bunch. I've been looking and haven't been able to find specifics yet.

In my experiences an arterial site will bleed more....for obvious reasons. The venous site will clot off a little quicker. For holding pressure, I ALWAYS hold about an inch ABOVE the site. This way when you release pressure you can still visualize the puncture site and see if the bleeding is subsiding. Holding directly on the site is ineffective because you can't really visualize the puncture. I have never heard of holding BELOW a site. Hope this helps!

Tracey

[kc ccurn]

If you hold pressure below the site you aren't occluding where the vessel has been cannulated. When the vein or artery is cannulated, the insertion site is distal to where the vessel itself is cannulated. Which means that you have to hold pressure proximal, or above, and a little medial to the site. Basically where the hole in the skin is, is NOT directly above where the hole in the vessel is. The hole in the vessel is (proximal) above the hole in the skin because of the angle of how the needle is put in to the artery or vein.

The doc was right that the reason the site kept bleeding was because of where pressure had been held. However there are a lot of other factors that go into if a groin site is oozing....is the pt on heparin/plt aggregators/blood thinners, etc, has the pt been moving and bending his hip, etc.

With groin sites it is important to keep a close eye on them because even if a site has closed, it can "pop" open anytime, that's why good pt education is important and observing the site after any positon change within the first 4-6 hrs. When in doubt hold mannual pressure till oozing stops. At our hospital we also use femstops, so we'll hold mannual for a while then place a femstop on at low pressure for a few hours to make sure we have good hemostasis.

Another pearl of wisdom, one that I learned the hard way. Always assess for numbness/tingling in the leg that has been cannulated, especially before getting the pt OOB. Sometimes when a hematoma develops it can put pressure on the nerve causing the numbness/tingling. Sometimes the pt has to have vascular surgery to remove the clot.