CCU - Removal of Femoral Sheath by Registered Nurses

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Policy and Procedures of Femoral Sheath Removals by Registered Nurses. If you have any information on these topics please let me know? I need to benchmark , and set up some standards for our hospital cardiac services.

Hello,

Well, usually during the procedure you are given a concious sedation(Diamorphine, Midazolam), it does take the edge of and it is tried to keep the patient as comfortable as possible. Some patients are more sensitive than others but you are allowed to tell the staff if you are uncomfortable, well that may not even be needed as the staff present is supposed to be monitoring you closely and any sign of discomfort from you is mentioned to the Consultant and a bit more of the 'Happy stuff' is given.

Well the sheath removal is done right in the lab obviously it depends on the type of ablation you are having or if because you had heparin and the ACT is above 150 seconds then the sheath is removed later on the ward once the ACT is about 150seconds.

In the first instance the nurse warns you when taking the sheath off and then pulls the sheath out during which it might sting or you feel a little pain after that manual pressure is applied on yout groin by the nurse and except for the pressure you must not really feel any discomfort.

However when the sheath is taken out later onthe ward by then the effect of the local anaesthetic wears of and so you may be given a bit of morphine before the removal of the sheath to avoid much pain and discomfort.

I am sure you will be fine.

I am a senior cath lab nurse.........I really do care for my patients and like keeping them as comfortable as possible.

Sonia

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literature review

add [color=#0033ff]added

[color=#0033ff]arterial puncture site management after percutaneous transluminal procedures using a hemostatic wound dressing (clo-sur p.a.d.) versus conventional manual compression: a randomized controlled trial. (includes abstract); mlekusch w; dick p; haumer m; sabeti s; minar e; schillinger m journal of endovascular therapy, 2006 feb; 13 (1): 23-31

add [color=#0033ff]added [color=#0033ff]bed-rest post-femoral arterial sheath removal- what is safe practice? a clinical audit. by: tagney, jenny; lackie, dawna. nursing in critical care, jul/aug2005, vol. 10 issue 4, p167-173

add [color=#0033ff]added [color=#0033ff]comparison of the femostop device and manual pressure in reducing groin puncture site complications following coronary angioplasty and coronary stent placement. by: walker, sandra beverley; cleary, sonja; higgins, monica. international journal of nursing practice, dec2001, vol. 7 issue 6, p366-375,

these are just a few i used for the policy i wrote. also lippencott online is a good resource. act less than 165. 20 minute manual compression and groin sites only. no brachial or illiac sheaths removed by rn staff. also we had a clause for coverage it the patient had received a thrombolytic in 24 hours the md had to remove the line.

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Specializes in CVICU.

To D/C a sheath - we use manual, c-clamp, or femostop (which requires a MD order r/t cost)

We start checking the ACT within an hour after the patient arrives from the Cath Lab and usually pull when the ACT is less than 175 sec. We check the ACT hourly if > 175.

We premedicate with Demerol 25 mg w/ Phenergan 12.5 mg IVP or Versed 1mg with Morphine 2mg IVP.

Many times I start with the c-clamp or femstop, minor oozing/hematoma forms and i resort to manual pressure ... anyone else?

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We Pull The Sheath If Act Is Less Than 150,in Terms Of Femostop Use ,we Need To Have Doctors Order.to Cover Ourselve.we Prefer Manual Pressure Unless Patient Has Big Body Built,with Hematoma Or Bleeding.

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Howdy, I figured I'd throw my 2 pennies in here too.

I pulled my first sheath way back in Jan. 1996, and have pulled somewhere around 2000 or so since. I have seen a variety of hemostasis devices and still prefer the first I ever used which is the fingers I am typing with. I have yet to have a vasovagal (sudden drop in BP and HR, related to increase in vagal tone) while providing manual pressure. I also use c-clamps w/ Compressor discs, but really when I have time prefer the manual technique. Having performed many pulls in my 9.5yrs. of nursing, I started using a procedure about 7 yrs. ago where I would infiltrate an oozing site with lidocaine 1-2% with Epi 1:100,000 to shore up any small vessel bleeding. The technique worked quite well, resulting in a more comfortable patient and achieved hemostasis from the localized vasoconstriction. About 2yrs. ago, I authored my hospital's "Lido w/ Epi injection Policy." After getting several "ignorant" doctors on board and explaining to them how the procedure worked, and getting pharmacy approval, and getting approval of the hospital medical board, we finally got them on our Post Intervention orders last fall. If any of you guys are interested, PM me and I will forward you a copy of the policy. I have a friend and former co-worker who left my facility and took this procedure to another facility and they are currently working on a similar such protocol. This injection works wonders esp. with Perclose or Angioseal sites that have the never ending ooze. This WILL NOT be effective on an arterial bleed, but does quite well with moderate oozing sites.

Doug

I would love to see that policy for our hospital....can you email it to me? Click on the envelope icon, below my member name (above).

Thanks so much

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hi everyone.. i'm wondering wat is the proper method for blood sampling for ACT.. any recommendation... this is wat i've been practising

1. draw out 20mls of blood (as to remove to remaining heparin which used to lock the sheath)

2. draw another 2mls (for ACT reading)

3. return back 20mls blood been drawn in step 1

4. flush with 10mls 0.9% normal saline

5. lock with 2mls of heparin saline

thanks

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