Sheath Pulls

[jackpp]

We have a huge issue at my hospital regarding sheath pulls. Typically, current practice is the nurse with the pt. likely is not certified to pull so an ICU nurse, often with a full team of patients must leave and do the pull. The nurses on the floor do not wish to learn how to do the pulls because administration often puts them in a horrible staffing situation (I.e.they have 5 or 6 of their own patients with an admission on the way oh and wait...pull the sheath, too.).

A group of administrators, and floor nurses are meeting in a few weeks to look at current practice and what can be done differently since the current way of doing things is not good. We will be looking at things like who should be trained to do pulls, what unit should these patients go to, nurse pt. ratios on said unit, etc.

I work at a small community hospital with approx. 187 beds so we don't have the resources the larger medical centers have. I do know, however, there's got to be a better way. Any recommendations would be great!!! Thank you in advance for any suggestions!!! I figure why reinvent the wheel right?

[ICULINDA]

Sheath pulls do take up time. I work ICU so I'm use to pulling them. We have to inform another nurse that I will be pulling a sheath in case anything goes wrong and so they can lend an ear to my other patient. If the charge is a free nurse that day they may do it for us or watch our other patient. Usually our sheath pts stay in ICU until the sheath is removed and they are not on any titratable drips. Amio, cardizem, heparin drips can go to PCU. Our PCU nurses have 3 pts. If you do get a sheath pt could other nurse keep an eye out for your others? How many do you guys get daily?

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[jackpp]

I should have clarified...the problem isn't in the ICU...it's when the sheaths go the our tele floor...and they have 5 or 6 patients.

[ac3070]

In my hospital (a bigger, 600-bed academic center) nurses from one cardiac floor are certified to pull and handle the pulls on the rest of the floors. That nurse is a resource nurse on her/his floor when not traveling around to pull.

[wellcoachRN]

I have worked in several hospitals as well as two cath labs and each handled this situation differently. The sheath pulls generally did not go to the cardiac step down unit with the exception that the patient had a closure device such as an angioseal. Other options I experienced varied from pts transferring to ICU as a procedure pt for sheath pulls then transferring to the step down unit, a dedicated post cath area in PACU or returning to the prep area for outpt caths. The prep nurses were trained but most often a tech or nurse would do the pull. Hope this helps! Good luck!

[Helori]

Does your hospital do out patient cats as well? In our hospital we have a holding room where the out patient sheaths are pulled and any admitted pts from the tele floors go there for the sheath removal then back to the floor for their bed rest. Any icu or ccu pts have their sheaths pulled on that unit. Although lately more and more of our docs are doing radials which is awesome for both the patient and the nurse :)

[ac3070]

Love a radial Cath! My favorite!