When pulling sheaths after a cath...

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?

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

Lots of facilities use a femstop device:

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!

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.

We have the residents or cardiology fellow do it

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!)

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

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