In our ICU, the patients usually come down from the cath lab with the sheath still in the groin, and the RNs pull them after a few hours. Until recently, we have not had too many problems with pulling them, a small hematoma on occasion, and a couple of pseudo aneurysms, but for the last two weeks, we have had some major complications. We have had five pseudos, two that required surgical intervention. We have also had two retroperitoneal bleeds, and one woman who bled so much she went into hypovolemic shock, arrested, and had to be intubated for two days. Thankfully, she survived. There have been no apparent commonalities between these cases. The caths were done by different cardiologists, and the sheaths pulled by different nurses. The cardiac docs are kind of blowing it off, saying it's just a cluster of complications, and that it's not significant that so many happened in a short time. Our Intensivist, who is also our medical director, wants all sheaths pulled in the cath lab with the doctor present. The cardiologists of course are against this. How do you handle arterial sheaths in your unit? Who pulls them, and has anyone else had these kinds of problems?
