Transporting TR band patients from Cath Lab recovery to inpatient room

[montyb79]

I work in a very large, high acute cath lab with a high volume of patients that were accessed via radial artery for their procedure. Typically, if a patient is being admitted that has a TR band (vasc band, radial compression device... Etc), and the room is ready for patient transport out of the recovery area, the recovery RN will not deflate the band if the room or Nurse on the receiving unit is ready before the entire band can be deflated. There is not necessarily a policy, rather a nursing judgment based on safety. Most obviously, should bleeding occur with a partially deflated band, who will step in and address the bleeding? (Mainly, I wouldn't trust that a patient transporter would be able to handle this should it occur on the elevator or in a long hallway). I had quite the discussion today with a receiving nurse, who was astonished that holding off on deflation until a trained/qualified staff member would be immediately available to address such an instance of bleeding..... I'm wondering if any other nurses practice this way, or any hospitals with existing policies that address this potentially dangerous scenario.

Thanks for any input

[offlabel]

No one is going to bleed to death from an arterial stick site, especially not in the time it takes to get to recovery. Maybe a big ugly hematoma or bloody hospital gown, but not much more in such a short time span.

[Pheebz777, BSN, RN]

If there is going to be any bleeding, any bleeding at all, all it needs is a little pressure. Inflate the vasc band another 2ml or more and you're good! If you're uncomfortable doing it, just apply pressure with your fingers for a couple minutes. There's no rocket science involved. No one will ever bleed to death from a radial stick (unless left neglected by RN).

[AgentBeast, MSN, RN]

These bands if they are going to bleed will bleed when bleed when you completely deflate the balloon and then try to separate the balloon part from the skin where the sweat, oils, and dried blood make it adhere to the skin. I've never had a band bleed when removing a couple mL's of air. It's always when separating the band from the skin, and even that happens in less than 0.01% of the thousand of band's I've removed. Twisting the band gently back and forth rather than just pulling it off the skin reduces incidences of bleeding.

[qestout, ASN, RN]

I'd rather they come back from recovery AFTER TR band is removed, but that's 50/50. And only reason why is because they are usually sent back with it when I have 4 other patients that need meds, and to be with them every 15 minutes is stretching my time. I've not had a problem with bleeding afterwards, so far.

[UmmIbrahim]

Hey all...where I work.

Big huge teaching hospital + level 1 trauma center on a Cards floor...generally for TR bands we the floor RNs deflate 60-90 min post procedure once in room. If a pt does well at procedure they come right to the room. Obviously if they have issues or an intervention is tricky or no beds to they begin to bleed immediately post cath then to the cathlab holding they go! In which case they come back deflated.

[UnbrokenRN09, BSN]

We have very specific protocols for air removal from our bands. But transporting patients with partially deflated bands is not an issue, provided protocol was being followed during deflation process.

I find it odd that RN's aren't transporting cath lab patients?? That just seems strange to me, we require 1 RN with every transport

[shamack4]

I work in a heart and vascular critical care step down unit (I know such a long name) and recover patients from cath lab immediate post op. We have specific MD-RN orders regarding activity , and steps to follow for deflation of the cuff. Also what steps to follow if any complications were to arise such as bleeding or hematoma at the puncture site. Generally one hour post op 3cc is removed q10 min until total cc are aspirated out of tr band cuff. The cath lab will call in report and confirm amount of cc inflated in tr band cuff. VS are the same q15 x4, q30 min x2, q1hr x2 the q4. Then when totally deflated tr band is removed from wrist and pressure dressing with tecaderm is applied over folded 4x4. Restrictions include no bps on limb for 24 hours and restricted activity of right wrist. Also cns checks should be frequent along with palpating pulses. Educate pt to report tingling or loss of sensation in between assessments