Cardiac Sheaths

[debthern]

Our pediatric PACU was informed that we would begin pulling sheaths at the bedside and no longer in the Cath lab is this appropriate? Is it done in other hospitals? Are the patients still sedated as ours will not be? HELP!!!

[elthia]

We pull sheaths on adult patients in a cardiac telemetry unit. Before being brought back to the floor from the cath lab, they have an Aldrete score of 8 or equal to their preprocedure score. They have continuous cardiac monitoring, pedal pulse monitoring, and Q15 vitals, except from the time the sheath is pulled until hemostasis is acheived, then they are Q3 minutes. Our nurse to patient ratio is usually one to four, and usually we'll only have one sheath patient at a time.

Sometimes I have had up to 6 pt's with one of them being a sheath pt... And when I do have 4 pt's with one of them being a sheath pt, the LPN's throw a fit because the have a higher pt ratio than the RN's with sheath pt's. I have had pt's vagal, hematomas, I had a pt throw a clot in the opposite leg than what was stented and go for an emegent fem-pop bypass at 0300. I had a pt with undiagnosed clotting disorder almost bleedout on me, I've had who was HIV+ try to pull the sheath out himself so he could go AMA. There is a reason for a lower nurse to patient ratio with sheath pt's.

Horror stories aside, 99% of the time when I pull a sheath everything goes fine. If the pt was on angiomax, then the MD orders a specific time for the sheath pull. If the pt was on heparin and a glycoprotein IIb/IIIa inhibitor, then we do serial ptt's until the ptt

Now when we are pulling the sheath, the charge nurse is supposed to take our phone and cover our pt's until the pt is stable.

[anonymurse]

If you use Femostops, have the Radi rep give some inservices.

[cardiacRN2006, ADN, RN]

We routinely pull sheaths on patients who come up to our CCU with stents. Versed and fentanyl are standard meds for our patients prior to sheath pull.

Wow! How generous!

Our pts get an amp of atropine on thier belly and a one liner about how this is gonna feel weird.

I also put the Pox on thier toe...

[tinabina612]

we pull sheaths on unsedated adult pts on the cardiac pcu that i work on. I hate it!

[MistyRN09]

Our cath lab lets you have a day or two pulling sheaths to prepare yourself for it. Maybe ask your cath lab if you can spend a day pulling? I do not pull sheaths, although I'm on a unit where it can be done. We have a team for that.

[rjm09]

I work on a universal bed telemetry/ CVICU floor. We often get pts back from cath lab with sheaths sutured into place. We remove sheaths when our ACTs are less than 175, hold manual pressure x20min, and apply a femostop only if we are still having problems with bleeding after that. Our pts diet is typically as tolerated after a cath, but we usually are pretty careful with letting them eat prior to sheath removal. It is NO fun when you have a pt vomiting while you are holding pressure on their groin site!