Pulling Sheaths on a Cardiac Stepdown

[ItalianRN, BSN, RN]

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?? Do we have a right to refuse this? We don't even have to do the hemodynamic compentencies, but they want us to be responsible for this unstable patients. This just doesn't make sense.

PLEASE RESPOND. THANK YOU.

[Bella RN, BSN, MSN]

Ridiculous and extremely dangerous. Those patients need to be in a 2:1 or 1:1 setting. And your unit doesn't have the proper hemodynamic monitor system. That is way too much responsibility on a stepdown floor. They are probably doing it for cost--Administration finds nurses to be so dispensible....But let the an arterial sheath be pulled and the patient bleeds out or forms a hematoma that goes unnoticed and they brady to low and a code is callled....then the powers that be will rethink that decision. Good luck!!

[Pinkster]

I worked on a cardiac floor, it was a step down unit. It was only a 15 bed unit and depending on acuity (we also had post op open heart pts) we would have 3-5 pts. We were expected to pull arterial and venous sheaths post cath, days and night shift as needed. Cath lab would get behind and have no room in holding. Sometimes we would only have 2-3 nurses on our floor total and be expected to pull a sheath. we would call a cath lab nurse (or one of there techs as they could pull sheaths)for help as it takes 30 min at a minimum. a 4 hour training course would be helpful. We had a packet and test to take, plus a day in cath lab pulling sheaths, and would have to do 5-6 and be signed off and boom there u go. we would never pull alone, and they would even do it with a nurse and a tech. thats what they do in the cath lab.

It was never fun, specially when cath lab is set up better, and they have one pt at a time and we have 4-5, but it was done ( i hated it!). It is definitely not an on stepdown. But it is going to be more common im sure.

what ever came of your situation?