When pulling sheaths after a cath...

Published

At our hospital we pull the sheats out that the doctors use during the heart caths. I was wondering if anyone had tips or a certain way that they do it. I seem to be having trouble stopping the blood and then I get paniced and have to call for help and this is getting to be embarrassing.

Any tips are greatly appreciated!

If I have a patient who needs sheaths pulled one thing I make sure of before ANY line comes out--I want a normal to low BP. I have been pulling sheaths for over 20 years and I have found that if the pt's BP is over 140 systolic, you need to hold pressure much harder. Either sedate the patient or get that BP down. I've seen too many blown arteries!

Just my :twocents:

Up Vote Up Vote ×
Our management has passed onto us that sandbags fail to meet Joint Commission standards. They don't allow for the visual check of the site. So we simply aren't allowed to use them any longer.

So what do you use now to keep pressure on it for longer periods of time?

Up Vote Up Vote ×
Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.
So what do you use now to keep pressure on it for longer periods of time?

Lots of facilities use a femstop device:

image002.jpg

Up Vote Up Vote ×
Specializes in cardiac ICU.

Like BBFRN posted, we use a Femostop. I've heard of other facilities that actually use the patient's BP measurements in adjusting the pressure applied at the site. Our P&P is simply written that it is to be placed at 40 mmHg originally, but can be increased to 60 mmHg. The only ways we are allowed to apply pressure at sheath sites are manual, Compressar clamp, or with a Femostop.

And thanks to BBFRN for posting the photo!

Up Vote Up Vote ×

Always have a 2nd nurse at the bedside with you with the initial pull. Then once everything is stablized, they can go as long as you have the call light handy! :)

My thing is this: ....

Have the 2nd nurse find the pedal pulse on the extremity with the sheath. While that nurse is actively palpating the DP pulse, you push some pressure on the groin where you think you would hold the manual pressure.

If you push pressure in the right area, then the DP pulse will fade out, and then you know that you'll be holding in the right place once you pull the sheath.

Up Vote Up Vote ×

We have the residents or cardiology fellow do it :coollook::up:

Up Vote Up Vote ×
Specializes in ER/Critical Care.
:yeah: Exciting update: Last night I had a sheath to pull, and before I even had the chance to ask for help I had two nurses (who I try to always go in the room with when they pull sheaths) volunteer to come in and help me! It was a really nice change, and I was amazed at how much more at ease I felt doing it. So I guess being proactive IS actually helping! Yay! (Sorry, I just had to brag-I was just so excited to see the change happening!)
Up Vote Up Vote ×
Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

That's great, iheart! You led by example, and they followed. Definitely makes for a better (and safer) work environment.

Up Vote Up Vote ×
Specializes in CCU, ED.

We always have two nurses in the room initially in case a hematoma forms and needs to be expressed.

Up Vote Up Vote ×
+ Join the Discussion