|
Procedure |
|
Rationale |
| 1. |
Check
INR/PTT. If INR/PTT is prolonged or patient has altered coagulation
(e.g. received TPA), the nurse does not remove the catheter. |
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. |
Perform hand hygiene and don non-sterile gloves.
Open sterile dressing tray and set up field. Remove old dressing, discard dressing and non-sterile gloves. Don sterile gloves.
|
3. |
In accordance with the MoHLTC 4 moments of hand hygiene and LHSC infection control policies in an effort to reduce risk of transmission of microorganisms and secretions. |
| 4. |
Cleanse
site with 2% chlorhexidine and 70% alcohol swab and remove any sutures. |
4. |
Chlorhexidine
2% is the recommended agent for disinfecting vascular access sites
at LHSC because:
-
it
has anti-staphylococcus properties that are equal to alcohol or providine
-
is
less irritating to the skin than iodine preparations
-
has
longer residual action than alcohol
|
| 6. |
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.
IN
THE EVENT OF CATHETER FRACTURE:
Apply
direct pressure over the site and notify the physician immediately.
If the catheter fragment is palpable, apply additional pressure distal
to the catheter.
|
6. |
Direct
alignment improves body mechanics and pressure application.
Clots
can form on catheter tips; these can embolize to the distal extremity.
Catheter
fragment embolism can occlude distal extremity circulation; urgent surgical
excision is required.
|
| 7. |
Apply
direct, manual pressure for a minimum of 10 minutes. Place pressure slightly above the stab wound. 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. |
7. |
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. |
| 8. |
When
bleeding has stopped, apply a 2 X 2 gauze or transparent dressing over
the site. |
8. |
The
transparent dressing protects against entry of pathogens while allowing
observation of the site. |
| 9. |
Remove sterile gloves and perform hand hygiene. |
9. |
In accordance with the MoHLTC 4 moments of hand hygiene and LHSC infection control policies in an effort to reduce risk of transmission of microorganisms and secretions. |
| 10. |
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. |
10. |
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.
|
| 11. |
Nurse
the patient flat without hip flexion for a minimum of 2 hours (longer bed
restriction should be considered for patients with increased bleeding risks)
(1).
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.
Transfers
to Floor
Do
not transfer the patient until the bedrest period has ended.
|
11. |
Hip
flexion or abdominal straining can increase femoral artery pressure and
risk for bleeding.
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).
The
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. |
| 12. |
Do not apply a pressure dressing. |
12. |
Cessation of arterial bleeding requires direct pressure; a pressure dressing provides inadequate compression, increases patient discomfort and can delay the detection of bleeding.
One
RCT (N 1075) showed 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). |
| 13. |
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. |
13. |
Bleeding
or bruising is an important complication following arterial catheter removal.
Impaired
circulation to the distal extremity can occur secondary to migration of
a thrombus or catheter fragment, hematoma formation or vascular injury.
Urgent
medical intervention may be required to restore limb perfusion.
|
| 14. |
Document
removal in the AI record and on the Kardex. |
14. |
To
communicate. |
Print
Handheld
Contrast
