I have recently taken a position on a cardiac floor in which I am required to take care of patients post intervention. This includes pulling sheaths. I am having some trouble holding pressure after the sheath is removed. I am wondering if I just need to beef up my wrist strength or if my technique needs some work. Any suggestions?
May 7, '07
I have pulled alot of sheaths. I think the two finger method works best.
Make sure you find that pulse and get on it. Hopefully, you are using
some type of closure patch to help you out. The c clamp is great and saves your hands for charting afterwards. We use the 10 minute, no-peek rule also.
Make sure the bed is at a good level for you.
Your wrists are probably fine, just have to get your technique down.
May 8, '07
Try abducting the leg so when presure is applied your pinning the artery against bone .This tech you know if youve got it or not.
May 8, '07
Make sure the bed is at the appropriate height.
May 11, '07
Things I always do. Make sure pt has voided, tell them not to tighten their stomach ( that will make it harder for you ) Make sure they are lying flat. Good bed height for you and if you can't feel the pulse before you pull the sheath then you need to apply pressure where you feel the sheath under the skin ( just wiggle the sheath and you can feel it under the skin) these things make it easier at least for me I have been doing it a year and no problems.. Also use the clamp if you have a really deep person. And I found out some thin people are hard to hold the artery rolls around you really have to bear down on that sucker....
May 28, '07
Two finger method is the way to go. You also want to hold pressure at least 2 fingerbreadths ABOVE the puncture site. This allows you to still see the site while holding pressure. Most people think that holding with a fist works better, but you have more control with 2 fingers and you can better monitor the site.
Feb 3, '08
I ususlly have the pt move as close to the side of the bed as possible and I always have another nurse there for the first 10 min of sheath pulling b/c there have been many times that the BP has dropped and we had to run fluids or give atropine with in the 10 min. but I prefer manual pressure over the c-clamp. I usually use the fist method b/c that's what I learned and we premeicate with vailum and perocet along with sq lidocane before we pull the sheath. I also talk to my pt's about something that relaxes them while pulling and holding pressure it helps relax the muscles and the pt is less likely to hold their breath or tense up causing bleeding or a possible hematoma. I also apply a sand bag after 20-30 min of manual pressure depending if the site clotted. I always wait untill the 20 min of manual pressure is up to check if the pt is bleeding. Only one time when I first pulled a sheath I wated 10 min and I lifted my hand to check, the pt started coughing and well lets say arterial spray...I immediatly put the presssure back. I also use a very very secure pressure dressing, I make the pt. bow their leg like a frog, make a diamond shape with the gauze apply it to the site along with another reinforcement on to and I tape from the leg to the mid back. It has worked so far..hope this helps!
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