One hour up and two out post cath.

Editorial Team / Admin · Jan 7, 2006

My advice is to follow the recommendations of the company that manufactures the closure device used. You don't mention which device is being considered, just curious: are you speaking of the internal devices: Perclose, AngioSeal, VasoSeal??? Or of the external ChitoSeal, Clo-sur P.A.D., D-Stat pads? AngioSeal touts theirs as 20 minutes down, d/c in 60 min. We're a little more conservative with ours (two hours down, then if no bleeding or hematoma and VS=stable, D/C home -- with instructions for minimal exertion X2 days, etc).

Good to have your general policy in place, however if the internal devices don't deploy properly, or the anatomy precludes using them, be sure you have policies/instructions for those situations. The exernal devices are cheaper and it's nice to have them to fall back on if you're unable to use the internal ones. We still keep the pts down X2-3 hr when using Clo-Sur P.A.D. (with HOB up 30 degrees), have had good experiences with it (really beats 6 hr flat!!).

What does the literature say, what are other ppl doing? Have you surfed some of the interventional cardiology and radiology sites?

Good luck!

bobbyg · Jan 9, 2006

What I'm trying to set-up is a policy, following the various company's recommendations, on ambulation and discharge following correct deployment of an internal closure device,[Angioseal or Perclose]. This would be for diagnostic procedures only. Our I.R. M.D.'s already ambulate within 30 mins., making sure they are not under the influence of a sedative, but our Cardiologists are alittle more conservative. I'm looking to see if anyone else is doing the same. Thanks for your help.

MedicalZebra · Jan 20, 2006

I had a cardiac cath with an AngioSeal-- and they still kept me in bed for 6 hours! I thought the whole idea behind the plug was to avoid that-- and it was never explained to me why it was done. The nurse at the end of the night had no idea why I'd been kept there that long, either.

zacarias, ASN, RN · Jan 21, 2006

Also if any antiplatelet is used like integrillin or aggrastat, you should be down for at least 2-4 hours no matter what closure system they used. Anyone agree?

austin heart, BSN, RN · Jan 21, 2006

Also if any antiplatelet is used like integrillin or aggrastat, you should be down for at least 2-4 hours no matter what closure system they used. Anyone agree?

I do and we keep our diagnostics around for a minimum of 4 hours not matter what the closure device.

nekhismom · Feb 10, 2006

We only have Angioseal, PerClose and StarClose in our lab. We have Clo-sure P.a.d. in the lab, but I've never seen it used. We rarely use PerCLose d/t pt c/o severe pain with deployment. We mostly use Angioseal.

Angioseal pts are on bedrest for 2 hrs post deployment, then can d/c if VSS, no other issues, etc. We do this regardless of anticoagulation status.

StarClose states that their pts can ambulate almost immediately. Our MD's still insist on 2 hr bedrest.

DutchgirlRN, ASN, RN · Feb 10, 2006

I feel better having my patients remain flat w/leg straight for 6 hours. I don't see any reason to rush them out the door. My mother had one last Friday, they used Per close. She didn't have any problems other than bruising. She said the whole thing was a piece of cake and she wished she had not worried ahead of time. I tired to tell her I've never had a patient come back c/o that it was bad, or hurt, or anything negative other than being thirsty, hungry or having to pee.

tvccrn, ASN, RN · Feb 14, 2006

If your patient's are in bed for 6 hours post-cath there is no need to charge them for a closure device as they could do without it. If the doctor insists on bedrest for that long after AND uses a closure device then the patient is being charged for something they didn't need. this is with the caveat that the device didn't fail and they are on bedrest simply "because that's what the doctor ordered."

The entire idea of arterial closure devices are to have the patient ambulating and discharged in the minimum amount of time. These developments are due mainly in part to the patient demands....why do I have to lay flat for so long, why can't I move my leg, I won't use a urinal/bedpan I have to get up to pee, etc.

Yes, it's also because the doctors want to move the patien'ts through faster and I am n ot saying that's the best thing. But, we have the technology why not keep up with the advances and use these things to their fullest advantage?

button2cute · Feb 19, 2006

Hello, TVCCRN

No matter what the technology is today. It takes one patient to have a complication that may cost his or her life. Then the policies will change to prevent any type of mishap again.

Therefore, caution is always on the side of the nurse and assumption is on the side of those who wants to rush the patient out.