|
Procedure |
|
Rationale |
| 1. |
Check
INR/PTT. If prolonged, notify physician. |
1. |
To
reduce risk of bleeding. |
| 2. |
Perform hand hygiene and don non-sterile gloves. |
2. |
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. |
| 3. |
Cleanse
site with 2% chlorhexidine and 70% alcohol swab and remove any sutures. |
3. |
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
|
| 4. |
Gently
withdraw catheter while applying direct pressure with the sterile gauze.
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.
|
4. |
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. |
| 4. |
Hold
direct, manual pressure for a minimum of 5 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. |
4. |
Prolonged
and direct pressure is required to stop bleeding from an artery.
Inadequate hemostasis can lead to bleeding. Hematomas can cause impaired
circulation to the distal extremity are cause pain for the patient. |
| 5. |
When
bleeding has stopped, apply a transparent dressing over the site.
DO
NOT APPLY A PRESSURE DRESSING.
DO
NOT APPLY DRESSINGS AROUND THE WRIST.
Remove gloves and perform hand hygiene, then remove facemask with shield. |
5. |
The
transparent dressing protects against entry of pathogens while allowing
observation of the site.
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.
CIRCUMFERENTIAL
DRESSINGS CAN COMPROMISE CIRCULATION TO THE EXTREMITY.
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. |
| 6. |
Minimize
limb activity for at least one hour post removal. |
6. |
To
minimize risk for bleeding. |
| 7. |
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. |
7. |
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.
|
| 8. |
Document
removal in AI record (CCTC), Kardex, graphic record (flowsheet) and line
tracking sheet (UC). |
8. |
To
communicate. |
Print
Handheld
Contrast
