After cardiac cath

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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?

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Specializes in Dialysis (All Modalities) , Ex-CVICU RN.

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.

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Specializes in cardiac/critical care/ informatics.

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

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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.

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Specializes in Cardiac Telemetry/PCU, SNF.

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

Cheers,

Tom

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Specializes in RETIRED Cath Lab/Cardiology/Radiology.

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. :)

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Specializes in rehab-med/surg-ICU-ER-cath lab.

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!

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Specializes in Emergency.

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

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Specializes in Critical Care Float - ICU / ED / PACU.

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.

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We have never put ice on any groin post-cath. Very rarely do we use sand bags. Manual pressure is the best method to stop oozing. The docs here like Starclose and Angioseal, bedrest for patients is 2 hours at the longest and then we get them up and walking, unless of course there is oozing. But that is rare.

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i've never heard of ice packs being used either, but i found this article. maybe you all are ahead of the game!

a randomized controlled trial assessing the use of compression versus vasoconstriction in the treatment of femoral hematoma occurring after percutaneous coronary intervention. (includes abstract); king na; philpott sj; leary a heart & lung, 2008 may-jun; 37 (3): 205-10 (journal article - questionnaire/scale, research, tables/charts) issn: 0147-9563 pmid: 18482632 cinahl an: 2009932867

abstract: background: the aim of this study was to identify the optimal management of femoral hematoma occurring after coronary angiography and intervention. these procedures carry little risk; however, femoral hematoma is a commonly reported complication, which other studies have suggested is under reported. the objective of this study was to compare the current anecdotal standard practice use of compression in the form of sandbag application with local cold-mediated vasoconstriction in the form of cold-pack application as a clinically more effective and well-tolerated treatment of femoral hematoma. methods: patients who developed femoral hematoma with a surface area of >/=30 cm(2) after cardiac catheterization were included in the study (n = 50). participants were randomly allocated to cold-pack therapy (vasoconstriction trial) or to sandbag (compression-control) application and provided consent before the procedure. each hematoma was measured at 30-minute intervals during a period of 3 hours. patient and staff satisfaction were also assessed using a questionnaire. results: a significant difference was observed between the 2 groups, with vasoconstriction (cold-pack application) being more effective in rate of reduction of haematoma (confidence interval 95% p

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Here are patient instructions given by 2 different institutions. From what I gather, it seems that the ice packs are used to minimize or relieve discomfort.

http://www.advocatehealth.com/system/info/library/articles/heartcare/invasive/cathicad.html

"When the sheath is removed from your artery, pressure is held for 20-30 minutes to stop the initial bleeding from the artery. An ice pack and sandbag is then placed."

http://www.universityhealth.org/body.cfm?id=38083

"Pressure will be held at the puncture site for 10-20 minutes to stop any bleeding. A bandage, ice bag and/or sandbag will then be applied to the groin area until you are ready to get out of bed."

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