vagal response in cardiac sheath pulls and use of trendelenburg position

getoverit, BSN, RN, EMT-P · Jan 20, 2011

We don't place people in trendelenburg for sheath pulls. I would think a vagal response would be better treated with atropine, possibly even premedicated if you anticipated a problem or there was a history of it.

Look up Dr. Trendelenburg's second paper on his own position, he advocated against it. Reason being is it "tricks" the baroreceptors in the carotids to thinking there's more volume than actually exists, which causes them to lose their effectiveness in maintaining vascular tone.

North2000 · Jan 20, 2011

I should have elaborated on our process, if a pt vagals during a sheath pull, we put them in trendelenburg and call in extra help to increase fluids, apply cold rag, treat nausea and if pt doesn't show improvement in HR/BP, atropine is then administered. Thank you for the Dr. T reference!

Da_Milk_of_Amnesia, MSN · Jan 21, 2011

I worked in CTSDU and when we pulled sheaths, atropine was always there at the bedside during a pull...We would open the fluids wide and have the atropine loaded and ready to go. Screw getting a cold rag, give em 1/2 an amp...the MDs where i worked didn't care what we did, just as long as we called them and got the appropriate orders n what not and i believe they had it as a protocol for us, we were all ACLS nurses

Editorial Team / Admin · Jan 21, 2011

Our Cardiologists recommend re-anesthetizing the groin before applying pressure and pulling the sheath.

Wonder if doing that affects the amount of vagal responses during sheath pulls?

North2000 · Jan 26, 2011

Most people come back around on their own or with the easing of manual pressure, We're ACLS cert also. I don't like giving drugs on a whim and the rag is just for pt comfort. Just wondered if anyone knew of actual studies on the procedure. Thanks anyway, Milk.

getoverit, BSN, RN, EMT-P · Jan 26, 2011

dianah, that's an interesting question about re-anesthetizing the groin and possible effects on vagal stimulation. I'd never thought about that before. do you guys have many vagal responses during sheath pulls?

and north2000, sounds like you're doing the same thing as us. My experience is also that most people come around on their own. we had a pt last week who went down into the 40s, syncopal, ashen, no peripheral pulses, etc. and he rebounded before I could get the atropine out (

I don't know of any actual studies, just anecdotal things...but I'll let ya know if I find out anything useful.