sheath removal P&P (femoral)

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Hi everyone;

Our facility is looking at starting to pull arterial/venous sheaths and as the units educator I am looking at writing up P&Ps for the procedures. I am inquiring to see if anyone would be willing to share their facilites P&P on sheath removal and Femostop application/removal. I would greatly appreciate the assistance.

Thank you in advance!!

Cindy

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Specializes in Critical Care.

Yeaaa. I don't think anyone is going to share their hospitals P&P as I believe they are 'confidential' -- Confidential isn't necessarily the right word...maybe proprietary? Idk. Either way someone may give you an idea of what they do but if you're looking for the whole thing I'm pretty sure it won't happen.

I used to pull sheaths on a step down unit. Long story short, It required 2 people and a ACT

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Specializes in Quality, Cardiac Stepdown, MICU.

Usually we inflate the Femstop to MAP or maybe 10 above MAP. At our facility we actually had CNAs pull the lines and hold pressure but of course an RN had to be present with atropine. Now we have a whole cath recovery unit, but even down there they have CCTs (which are basically CNAs) pull the lines with the RN.

Who writes the rest of your hospital nursing procedures? Most facilities have a "best practices" committee or some other such thing. And I'd check with whoever is pulling the lines now -- cath lab or ICU? Another great resource is company reps, especially the Femstop folks (is that St. Jude? I can't recall offhand from home). They'd probably love to bring you all a lunch-n-learn.

You didn't mention what unit is pulling the lines. If it's a PCU or stepdown, remember that nurses pulling lines require fewer pts than those who are not; anything above 4 is wildly unsafe. Though if you are a union shop of course they probably have rules too.

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Personally, the best result comes from digital pressure. A vascular surgeon said to me press for 2mins per French size ie. 10min for 5french. I just don't like femstop. Have seen a few bad results. People seem to think it is set and forget. But if the patient moves,haematoma can form if femstop is not adjusted.

We use the TR band for radial access. Dr preference but usually 10-15mls for 2 hrs, then start reducing by 2mls 5-10 minutely

If femoral left in post PCI then it is removed when ACT less than 150sec. Have seen it removed by the cardiology registrar or Cath lab nurses in different establishments.

Watch out for vasovagal, have atropine, metaraminol, IV fluids on standby and a second nurse in vicinity

PULLING IS A SHEATH IS NOT TO BE RUSHED, VERY IMPORTANT PART OF THE PROCEDURE. BEST RESULTS ARE BY THOSE WHO PERFORM THE PROCEDURE OFTEN

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Several of our hospital's interventional cardio doc's have different criteria for pulling one of their sheaths. ACT times for example, some want

also, we always hold manual pressure and generally reserve FemStop's for bleeding complications (like excessive oozing) as we need an order from Dr to apply one.

This info isn't necessarily in our 'policy' but just general good practice.

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Specializes in CVICU, CCU, Heart Transplant.

My hospital's practice:

Lines are pulled by the department who placed the (i.e. Cathlab tech). This is because the nurse needs to be free to manage the patient.

1) Verify ACT

2) When the sheath is removed, manual pressure is held over insertion site for 20 min, and if no A-line is present, obtain NBP q 5 min. A Nurse must stay at bedside while tech holds pressure.

3) After pressure dressing is placed, the nurse inspects site with tech - notes any hematoma.

4) Vitals and Vascular checks q 15 x 4, q 30 x 2, then hourly until bed rest over

5) If not indicated in the order, One our of bed rest for every french ( i.e. 4 hours of bed rest for a 4 french sheath)

6) We only place a femstop with an order when oozing continues after manual pressure is held, starting at 50 mmHg, making sure to check pulses on limb it's placed on.

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Specializes in ICU.

Also include WHO can pull the sheath. Some step down units allow the CNA to do the actual pulling as long as an RN is within earshot. (not on my license you wont! :sneaky: )

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Specializes in Cath Lab & Interventional Radiology.

I can't imagine a CNA pulling the sheath! At my facility we only pull sheaths in CCU, Cath lab or PCU. The other hospital in town only allows CCU and Cath lab to pull sheaths. I work in PCU and this is manageable mostly because of our 3:1 ratio. I couldn't imagine having any more patients and having to pull sheaths. We pull a majority of the sheaths in PCU. Two nurses must be present. We always have atropine at bedside and a full bag of fluids running just in case. ACT must be

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