Femostop and patient acuity

[Tawnee]

I work in an area where we recover patients post cardiac cath. We are using the femostop in two different ways. One, at a low pressure to serve the same function as a sandbag. The other, at a high pressure to achieve hemostasis. In the past, the cath lab nurses would hold pressure until hemostasis but are no longer taking the time to do that; so we are now getting more patients with femostops at high pressure. Our ratio is 4:1, but I think a patient that has not achieved hemostasis should require a higher level of care/observation. I'd like to know if other facilities change the acuity level of patients in this situation

**If you have a patient with a femostop at high pressure to achieve hemostasis, is that patient considered 1:1, 2:1, 4:1?

**Does anyone know of any online resources that would help me justify increasing the acuity level of this type of patient?

[Virgo_RN, BSN, RN]

We use C-clamps at our facility, and from the time the sheath is removed until the time the clamp is off, the patient is, in effect, 1:1 care. Since this is such a short window of time, so long as your other patients are stable, it's doable to have a full patient load. Any problems, though, and things can turn dangerous. That's why it's important, in my opinion, to have extra staffing for the purpose of doing sheath pulls, assisting with admits and discharges, chart checks, etc. IMO, there should be at least one nurse on the floor at all times who does not take a team, but floats and helps where needed. This should not be a luxury.

[CABG patch kid, BSN, RN]

Our patients come up after hemostasis is achieved, but we used to pull sheaths on our floor. The ratio is 3:1 but if the nurse was pulling a sheath, she would be 1:1 with that patient and the charge nurse would cover her other 2. IMO, any patient who has not had hemostasis is a 1:1, even with Femstop (you have to check pulses Q5min) and even after hemostasis, you are supposed to check pulses Q15x4, then Q30x4, etc. That patient will be keeping you busy for awhile.