New nurse question about cardiac cath dressings

[telecraz]

I'm a new RN working on a telemetry floor in LI NY. we get lots of pt's s/p c.cath and I'm not familiar with the dressings they apply, e.i. angioseal etc. What are the different types of dressings I should expect to see, which ones would I remove, which ones disolve on their own? Up till this point I have just been check for s/s of bleed or hematoma- but don't have a clue as to what type of dressing/seal I'm looking at since often it never gets told to me in report & I never can find it in the chart. Can anyone explain to me the different ones and maybe describe what they look like & how to care for them. Any info would be appreciated thanks:D

[houselover]

There are several types of closure devices (both external and internal). The choice of closure devices, or lack thereof is at the discression of the doctor and availability of the device at your particular hospital. As bedrest times differ for each kind, it is important to know which kind is used. Internal devices such as perclose and storificeal is kind of like a stitch to the artery, with a rapid recovery time. Plug devices like angioseal have a moderate recovery time. External devices like chitoseal are long recovery time. Your best butt-covering method is to obtain the information in report - what was used, how long bed rest etc. Always err on the side of caution. I did find a website that may help you. An article called Percutaneous Femoral Access and vascular closure devices. www.sis.org/docs/2007 yearbook_ch1.pdf. Good luck to you.

[dianah, ASN]

Here's an article comparing the external closure devices:

http://www.medcompare.com/quickpicks.asp?qpid=375

I suggest you either request your Nurse Manager or Unit Educator arrange an inservice on the various devices used in your facility, possibly given by one of the Cath Lab crew or the vendors (who will, understandably, be biased).

I agree with houselover, you should receive that information in report, or it will be in the procedure report or in the MD notes or in the RN procedure notes.

Good luck! :)

[telecraz]

Thanks a bunch :wink2: - the MD does write orders for VS & BR durations. I also agree with Dianah that a visit to my cath lab would be helpful.

[al7139, ASN, RN]

Hi, I work on a Telemetry unit in VA. We get cath patients with lots of different closure devices. In report, the cath lab RN's always tell us what the result of the cath was, what closure was used, what the vitals are, and when they are off bedrest. All sheaths are removed prior to the pt leaving the cath lab. I agree with the other posters, you really need to spend a day in the cath lab to get the knowledge you need. I did during my orientation, and it helped me so much.

Amy

[telecraz]

thanks, sometimes I don't know if it's being a new nurse or if it's the hospital I work in, of why I often feel so overwhelmed. What is the nurse pt ratio in your facility? We are support to have 6 pts- but we often have 8. I was an honor's student and still study all the time, yet still don't take a break, come in early & leave late. I had 3 months orientation and then was on my own- half of that being classroom MEDsurg stuff mostly- which I honestly found to be just a brief repeat of stuff I already knew since I just graduated- & actually some of the things they taught us were outdated by 4 years- the school I went to always taught us the very latest evidence based nursing. We are one step below ICU & the pt's are very critical, half our staff are new grads- scary I know- I love cardiac though & always wanted to go into it. Sometimes ICU RN's float to our floor & they often say- how can you work on this unit? See, as a new nurse I have nothing to compare this experience with & wonder how other tele units work. Thanks again