Hold pressure where?

[dudette10, MSN, RN]

Had a pt return to the floor s/p RLE angio with stenting. The transferring nurse said the doc went through the R femoral artery instead of the L femoral artery. Ok. Then she said, "If he starts rebleeding, hold pressure distal to the insertion site, not proximal, because of the catheterization approach."

The patient didn't rebleed, so I never had to hold pressure, but her instructions to me didn't make sense. Isn't it the direction of blood flow--not the procedure approach--that determines where you hold pressure?

[Rose_Queen, BSN, MSN, RN]

Wouldn't it be best to hold pressure directly on the vessel's puncture site? Most approaches are at an angle; if you're being told to hold pressure distally, then the vessel puncture is lower than the skin puncture, meaning the needle/wire/sheath went in at an angle downward. Most of the docs I work with stand at the legs and angle upwards, so we hold pressure about two finger breadths above the skin puncture site to put pressure directly on the vessel puncture.

[dudette10, MSN, RN]

Got it! Thank you! I misunderstood the reason for holding pressure proximal to a usual approach. Your explanation makes perfect sense!

[Rose_Queen, BSN, MSN, RN]

I'm also going to guess that the stenting took place distal to the femoral artery? Otherwise, the downward angle approach doesn't make much sense to me. Then again, I'm OR, so our stents are typically femoral, iliac, and aortic so we're always working proximal to the puncture site.

[dudette10, MSN, RN]

I'm also going to guess that the stenting took place distal to the femoral artery? Otherwise, the downward angle approach doesn't make much sense to me. Then again, I'm OR, so our stents are typically femoral, iliac, and aortic so we're always working proximal to the puncture site.

Yes, they were. Presented with worsening right leg pain d/t cellulitis exacerbated by PAD.