Post care of a perclose?

[rng2013]

I work in a cardiac med unit where we also have 8 post angioplasty recovery beds where I'm now being trained. My question is about perclose... I was told there's nothing we really do with them. They come back from the cath lab with a tegaderm on top and it sounds like they're sent home with that and told they can take off the dressing the next day. Anyone have any experience with this?

[gigglestarsRN]

We take these patients frequently on my floor and are a cardio thoracic step down unit. We keep them on bed rest post hemostasis for 4-6 hrs depending on drs orders then begun to come off bed rest and ambulated. If no bleeding or hematoma, they go home next morning, perclose or other closure. Pretty straightforward as long as no bleeding, and yes to tegaderm, often over a thrombix pad on our unit.

[rng2013]

We take these patients frequently on my floor and are a cardio thoracic step down unit. We keep them on bed rest post hemostasis for 4-6 hrs depending on drs orders then begun to come off bed rest and ambulated. If no bleeding or hematoma, they go home next morning, perclose or other closure. Pretty straightforward as long as no bleeding, and yes to tegaderm, often over a thrombix pad on our unit.

Ok thanks! This might be a dumb question but what does it typically look like under the tegaderm? I'm just having a hard time visualizing this.

[VANurse2010]

Ok thanks! This might be a dumb question but what does it typically look like under the tegaderm? I'm just having a hard time visualizing this.

It's just a little pinpoint puncture-type wound.

[nursej22, MSN, RN]

Our Perclose patients may have the HOB up to 20 degrees immediately, out of bed in 2 hours. Diagnostic caths go home the same day, interventions stay over night. Have seen them them fail and twice the artery was sutured closed and required immediate surgery.

[michlynn, BSN, RN]

I take care of these patients on a daily basis, the floor I work on is the pre/post cath unit. Our cardiologists use various closure devices and Perclose is one of them. Every cardiologist is different but typically bedrest depends on how difficult the intervention was and how much of an anti-coag was used. Orders are usually HOB less than 30 degrees with the leg completely straight for at least 2 hours but can be up to 6. Dressing stays on until the next morning and if "oozing" occurs then we usually bupivicaine the site which is under our protocol. We check the site every 15 minutes for hematoma and bleeding and hold pressure if need be. Hope this helps!

[canned_bread]

I work in a cath lab. Post care is checking the groin every 15 minutes afterwards (like a normal groin post cath, with no perclose). We instruct the patient of normal care of the groin afterwards. You still need to check for haematoma and ooze afterwards as the perclose CAN and often DOES fail. The stitch will dissolve over time.

[Reaumeja]

Two hours seems like a fast 'up time'. Is there a reason why 2 hours is the norm there? We usually have a minimum of 4-6 unless severe circumstances require HOB elevation.

[nursej22, MSN, RN]

It is the manufacturer's recommendation for 2 hour ambulation with 5-8F sheaths.

http://www.abbottvascular.com/docs/ifu/vessel_closure/eIFU_Perclose_ProGlide.pdf

Many patients are very uncomfortable flat on their back, and have difficulty voiding. They may need meds and/or catheterization. I think the fidgeting they do puts them at increased risk for bleeding. So shorter down time can equate to less sedation, decreased risk of CAUTI, and increased patient satisfaction.

In my experience, if it is going to fail, it does so immediately.