Hematoma post Angiogram

[AussieKylie]

Hi There

I would like to know more about post angiogram patients who develop hematoma to their femoral artery site. What is involved nursing wise in managing hematoma?

Look forward to your reply

[jmgrn65, RN]

pressure needs to be applied until hemostasis has been established. Pressure drsg with possible sandbag in place freq. monitoring of site and pulses/circulation.

[oMerMero]

also monitor hgb, and DO NOT apply a hot pack

[Spatialized]

Usually, direct hand pressure works very well for helping the hematoma resolve, although there are times when no matter what you need to put the clamp or fem-stop back on. We've found on our unit that sandbags are not as effective as direct hand to site pressure, something about weight distribution and all. Beyond that, VS, distal pulses, checking for oozing/bleeding and in more serious (i.e. bigger) cases, serial H & H. I think the theory my unit has been operating on is to reduce incidence by increased monitoring...we're checking sites every hour after they're "stable". Sucks to have to wake folks up at night, but it's better than the alternative.

Cheers,

Tom

[nservice]

I agree with all of the above. Also check the abdomen for distension (retroperitoneal bleed).

[anonymurse]

Go to www.radi.se (makers of the FemoStop+) and sign up for their courses. It may take a couple of days for them to confirm you as a student. There's some great simple courseware there on the formation and treatment of femoral pseudoaneurisms (this usually gets called a hematoma but is differentiated by blood circulating in and out of the pocket from the femoral artery). Of course the site is designed to sell their product, but the research looks sound.

[Marchantia]

The first is to try and apply manual pressure 2-3 finger spaces above the angio site. also remember to call for a backup, a person who will be monitoring the patients vitals etc. sudden drops in pressures may indicate a massive blood loss, which would neeed to be corrected with fluids. plus also recheck haemoglobin levels which will provide guidance wether or not the patient needs to be transfused with blood. assess the patient's pain levels (some pain is expected on the site where manual pressure is applied), some relaxants may be prescribed in order to calm the patient (a patient that does lay still and allow you to effectively apply manual pressure will only in turn make things worse for himself). in cases where all atempts to reduce or control the hematoma fails, the vascular surgery team may be called upon for a consult.

[sharann, BSN, RN]

We had one in the PACU once and the cath team came in and "massaged" the large hematoma. What does this do and can you tell me why they do this? Thanks. Aslo when would a Femostop device be indicated for hemostasis when there is no longer a line involved?

[muffie, RN]

if pt is in hospital awaiting cabg on anticoagulants of some type you may want to mark the hematoma with a permanent marker to evaluate the progression of it

[West_Coast_Ken, BSN, RN]

Go to www.radi.se (makers of the FemoStop+) and sign up for their courses...Of course the site is designed to sell their product, but the research looks sound.

Be careful, be very careful when using any product. READ the manufacturer's instructions and FOLLOW them.

We had a pt who had a Fem-Stop applied and it was contraindicated (don't know the specifics; I was not involved) but I did attent the staff meeting where this product was discussed and the mfgr specifically states in their literature what should and should not happen when using this product. Know and FOLLOW their guidelines.

[RVMI73]

on our unit we usually check for the coag of the patient..or if she/he ahd clexane or not..then after that we applied pressure on the site wih kaltostat dressing with adrenalin on it and put it on top of the site and plus pressure bandage...be sure to check the pedal pulses esp the affected site..i hope this help...i prefer manual pressure rather than fem stop..