Pulling Sheaths on a Cardiac Stepdown

[ItalianRN]

We were recently informed that we are going to start pulling sheaths, post PTCA's, on my floor. We get 5 pts during the day (up to 6), & normally 6 pts at night (up to 7 at times). None of us, except our Manager, feels this would be safe to do. The training that only a select few are being offered, is 4 hours in ARU.

I was told that my hospital tried this a while back, but stopped it because someone died. I guess it was so long ago that the powers that be have forgotten about it. I do not want to put my license on the line for this. Neither do my co-workers.

We spoke to some of our CCU nurses & they think this is insane. They told us that they don't even like pulling sheaths. We'll have to do this with at least 2 nurses because the pt. usually vagals out & has to receive Atropine immediately. I think this whole idea is insane!! Any thoughts of what we can do to protect our jobs & our license in this upcoming situation??? Even some of the docs are against it, but most of them don't care either way. Nice, huh??

Thank you for your responses in advance.

[Virgo_RN, BSN, RN]

It really depends on the other three patients. If you have a couple walkie-talkies, maybe one person who's a bit sicker, and the sheath patient, it's not a problem. The sicker the other three are, the harder it is. This is why we fight to keep our patient ratio at four to one. If administration increases our patient load, I foresee an exodus.

[jjdennis1279]

it sounds like you are at one of those crossroads in life where you will be making a choice which will take you down two different paths. If you take the ethical stance in the sake of pt safety and safe practice for you it could mean your job at worst. If you just submit and go with the flow of an unsafe environment you will probably find yourself in a situation that you did not want to be in, pulling a sheath with unexperienced staff, with complications can go from bad to worse in seconds. You always have to choose how you will practice. If my leaders ears were that deff I would be looking for a new job. good luck, i applaud your energy

First, I should mention that I am I a new graduate nurse with only 3 months of licensed experience under my belt (although my scrubs don't have a belt). I'm currently working working on a cardiac med/surg unit that has a union mandated 4:1 patio to nurse ratio. Prior to being an RN, was patient tech in non-union hospital on a CCU and had my student preceptorship on cardiovascular recovery unit (primarily s/p open heart surgery). I'm having trouble reconciling my various experiences regarding sheath pulls and what is currently being practiced at my hospital. In the the previous two hospitals I've worked/studied in, sheaths were only pulled in an ICU setting usually with a 2:1 ratio and plenty of support staff (other nurses or residents(. In my current place of employment, sheaths are pulled on on the tele med/surg unit with a 4:1 ratio (and barely another upright sole within earshot). Although, tshe patients are continuously monitored via telemetry and a psuedo crash cart is on-hand. I'm concerned that what we are practicing is not safe. Unfortunately, I don't have the experience, nor job security, to justify my position. Any sound advise would appreciated.

[MERRYWIDOW46]

WOW!

When I worked cath prep and recovery we pulled all the sheaths. Patient ratio was 1:2-3 (on rare short staffed days 1:4, but still doeable), frequent vitals (Q15x4, Q30x4, Q1x4), continuous manual pressure. Other nurses in ear shot. Very few patients ever vagaled down. IF NECESSARY for rare cases we did have a fem-stop but was rarely used.

When working CVSD (cardiovascular ICU step-down), status post open heart, cath, mi, pacemaker, vascular surgery. Ratio 1:4 (rare days 5), we had competency to pull epicardial pacing wires and central lines, required to do 20 supervised with either MD, Senior Nurse, or NP, then could pull alone. We NEVER were to pull sheaths, that was an MD or NP responsibility.

Good Luck.

Check with your BON and see if this is even in your scope of practice, and what their stand is on it. I work in an East Coast Large City Teaching Hospital, RNs are not permitted in this state to pull PICC lines unless are PICC certified. I did a compact state mini-contract in Utah this summer and the LPN/Charge Nurse on Tele was upset when I said I do not pull PICC lines. WHY NOT she asked, I replied it isn't in my scope of practice in my original licensure state and have never done it. SHE promptly went and pulled the line, don't think she held pressure for a full 5 minutes as she was quickly back at the desk. I CYA'd and documented PICC line discontinued by Nancy Nurse, LPN in my note.

GOOGLE the literature about pulling on tele/step-down. GOOD LUCK.