Cardiology in Critical Care
Cardiovascular Anatomy and Physiology
Sterile tray with suture removal scissors.
2. Chlorhexidine 2%.
3. 2 - 4X4 gauze squares.
4. Transparent dressing.
5. Bedside stool (if required).
|1.||Check ACT. If ACT is prolonged or
patient has altered coagulation (e.g. received TPA),
notify the physician.
NOTE: Prior to removal of a femoral line sheath obtain order to remove sheath.
|1.||To reduce risk of bleeding.|
|2.||Obtain a bedside stool if required to ensure that nurse is positioned above the femoral artery when applying pressure.||2.||Direct, downward pressure is required to compress the artery.|
|3.||Cleanse site with 2% chlorhexidine and remove any sutures.||3.||Chlorhexidine 2% is the
recommended agent for disinfecting vascular access
sites at LHSC because:
|4.||Gently withdraw catheter while
applying direct pressure with the sterile gauze.
The nurse should be positioned directly over the femoral artery using his/her body weight to provide direct pressure.
Inspect catheter for clots and ensure entire catheter has been removed.
THE EVENT OF CATHETER FRACTURE:
|4.||Direct alignment improves body
mechanics and pressure application.
Clots can form on catheter tips; these can embolize to the distal extremity.
fragment embolism can occlude distal extremity
circulation; urgent surgical excision is required.
|5.||Hold direct, manual pressure for a
minimum of 10 minutes. Carefully check the site.
If oozing continues, compress for 5 more minutes before
checking again. Hold direct pressure for a minimum
of 5 minutes after evidence of bleeding has stopped.
NOTE: For femoral line sheath removal, 20 minutes or more of pressure might be required. Ensure bleeding has stopped before discontinuation of pressure.
|5.||Prolonged and direct pressure is required to stop bleeding from an artery. Inadequate hemostasis can lead to retrograde bleeding. Hematomas can cause impaired circulation to the distal extremities and are painful for the patient.|
|6.||When bleeding has stopped, apply a 2 X 2 gauze or transparent dressing over the site.||6.||The transparent dressing protects against entry of pathogens while allowing observation of the site.|
|7.||Immobilize the leg. A sandbag can be used to remind the patient not to flex the hip. An ankle restraint can be used to promote immobilization.||7.||Sandbags WILL NOT stop bleeding;
they are used to restrain the leg and to remind the
patient not to flex the hip.
Immobilizing the leg can minimize
the risk for bleeding.
|8.||Keep the patient flat without hip
flexion for a minimum of 6 hours (longer bed restriction
should be considered for patients with increased bleeding
The patient may have a pillow under his/her head, but should not be allowed to lift their head or flex their hip. A sandbag can be applied to remind the patient not to flex the hip (but will not provide any hemostasis).
Avoid the use of the mechanical vibrator during the period of bedrest.
|8.||Hip flexion or abdominal straining
can increase femoral artery pressure and risk for
A review of the literature and evaluation of the complication rate in patients following implementation of a 2 hour bedrest protocol post cardiac catheterization supported a reduction in the duration of bedrest from 6 hours to 2 hours (1).
potential for the mechanical vibrator to increase the
risk for bleeding has not been established, however, it
is reasonable to avoid activities that might
theoretically increase bleeding risk.
Immobilization of the leg during the bedrest period is important; transfer requires movement from one bed to another. The patient requires close monitoring of the site and distal extremity and the nurse:patient ratio on the floor may be insufficient.
|9.||DO NOT APPLY A PRESSURE DRESSING.||9.||CESSATION OF ARTERIAL BLEEDING
REQUIRES DIRECT PRESSURE; A PRESSURE DRESSING PROVIDES
INADEQUATE COMPRESSION. PRESSURE DRESSINGS CAN INCREASE
PATIENT DISCOMFORT AND DELAY THE DETECTION OF BLEEDING.
(1) Pressure dressings cause increased nausea, back pain, groin pain and urinary complications in patients treated with pressure dressings versus no pressure dressing. There was no difference in bruising between groups; the group with pressure dressings had less bleeding (that required manual pressure), however, bleeding occurred later in the pressure dressing group. (2).
|10.||Assess site for bleeding and
evaluate distal extremity for color, circulation and
motion q 5 minutes X 30 minutes, q 30 minutes X 2 then q
1 h X 4.
Apply direct pressure if bleeding is detected.
REPORT ANY CHANGES TO THE PHYSICIAN IMMEDIATELY and document in clinical record.
|10.||Bleeding or bruising is an
important complication following arterial catheter
Impaired circulation to the distal extremity can occur secondary to migration of a thrombus or catheter fragment, hematoma formation or vascular injury.
medical intervention may be required to restore limb
|11.||Document removal in AI record (CCTC), Kardex, graphic record (flowsheet) and vascular line tracking record (UC).||11.||To communicate.|
1. Vlasic, W., Almond, D. (1999). Research-based practice: reducing bedrest following cardiac catheterization. Can J Cardiovasc Nurs. 10(1-2):19-22.
Botti, M., Williamson, B., Steen, K., McTaggart, J., and Reid, E.
(1998). The effect of pressure bandaging on complications and
comfort in patients undergoing coronary angiography: a
multicenter randomized trial.
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