Arterial and Venous Sheath Removal Policies

[mcgowenl]

I work on an outpatient interventional unit in a moderately sized hospital. Currently, our "policy" is to do post sheath removal vital signs q15min x4,q30min x2, then hourly x4. This seems excessive-especially after just venous sheath removals from ablations. The bedrest is up before the vital signs! I'm interested in what other hospitals do--provided it is an uncomplicated sheath removal, and manual compression is used. Thanks!

[CSizemore RN]

I am currently on a critical care floor with CV focus. We do post sheath removal vitals q15min x 1hr, q30min x2hrs, then hourly x4 so we have an extra hour of q30min vitals in there. We are a pretty small hospital too but have a fairly high acuity. Most of our pts are inpatient at least 2 days post precedure.

[Kerrigan 06]

Ours is similar. Our patients fresh from the cath lab, sheath or no sheath, get vitals q15min x 4 sets, q30min x 4 sets, and q1h x 4 sets: 7 hours' worth. If they come with a sheath, the process starts over post-sheath removal. Our standard post-cath orders do say something to the effect of "frequent VS x7 hours post-removal per protocol," so it's not just a coincidence that there are 4 sets of each frequency.

It doesn't seem excessive to me, but I still have limited experience and I don't think I've ever pulled a venous sheath and not an arterial. Also, it's not such a big deal for working in a CVICU where the monitor automatically takes BP however often I tell it to!

[cvicugirl, BSN, RN]

Sounds entirely reasonable to me. Ever have an uncomplicated manual sheath pull blow on you? I'd rather catch it sooner than later.

[ckc6977]

Again our policy is similiar. Q4 x15min, Q30 x4, then q4H x24H.

It does seem excessive to obtain VS that frequently BUT once you've had one "gone bad" it's hard to think that way ever again!! :-)

[heartlover07, RN]

We have the exact same procedure after any cath lab/EP visit. Seems reasonable to me, the other day a young woman (49) coded and died on our floor after an "uncomplicated" stent placement. She bled internally, hgb went from 12 to 5 in 1 HOUR! Its really a shame, she had back pain and constipation pre-procedure, so when she complained of pain in her back and feeling bloated (not sure of her vitals, i think some widening map) it was not caught. It was not my patient, but I can tell you i will be HYPERvigilent after that!!