PROCEDURE FOR REMOVAL OF FEMORAL ARTERIAL CATHETERS

Equipment Needed:
  1. Sterile tray with suture removal scissors.
  2. Chlorhexidine 2% and 70% alcohol swabs.
  3. 2 - 4X4 sterile gauze squares.
  4. Transparent occlusive dressing.
  5. Non-sterile gloves
  6. Sterile gloves
  7. Bedside stool (if required).
     

     

Procedure

Rationale

Approved nurses in CCTC may remove femoral arterial pressure monitoring catheters. Removal or large femoral sheaths used during cardiac catheterization or balloon pumping is not an approved skill in CCTC. Nurses approved in CCU/cardiac cath lab to remove cardiac catheterization sheaths may remove them in CCTC.

1.

Check Coagulation Tests/Medications

Check INR/PTT and platelets. If INR/PTT is prolonged (INR > 1.5) or platelets < 50,000 review orders with physician.

If patient is receiving any medications that affect coagulation (e.g., anticoagulants, fibrinolytics, antiplatelet agents), review with physician prior to removal.

 1.

To reduce risk for bleeding. If the patient has a significant coagulopathy the removal order should be reviewed to determine whether treatment is warranted (e.g. administration of plasma or platelets) or whether removal should be delayed.  Medications that interfere with clotting should also be reviewed.

The catheter site may also influence bleeding risk. Additional site pressure may be required.

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. 

References:

1. Vlasic, W., Almond, D. (1999). Research-based practice: reducing bedrest following cardiac catheterization. Can J Cardiovasc Nurs. 10(1-2):19-22.

2. 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.
 

November, 2000
Last Update:
May 25, 2016 , May 26, 2016
Brenda Morgan, Clinical Nurse Specialist, CCTC

LHSCHealth Professionals

Last Updated May 25, 2016 | © 2007, LHSC, London Ontario Canada