Cath Lab Digest

4. Inflate the balloon by injecting 15 cc of air through the one-way valve in the side port using a special syringe provided with the kit. Do not discard the syringe, as it will be used at a later time to deflate the device. Keep syringe in a plastic bag attached to patient’s chart.

5. Remove the sheath as the balloon is inflated.

6. Slowly withdraw air from the TR Band 1 cc at a time, until there is blood oozing from the puncture site, at which time 1 cc of air can be re-injected into the balloon.

7. Use sterile gauze or swab to wipe any excess blood from underneath the TR band.

8. Check capillary refill and pulse oximetry of the affected hand after the device is secured.

Nursing Assessment in the Holding Area

• Monitor site for bleeding, hematoma, or ischemia.

• Place sensor for continuous monitoring of pulse oximetry in the affected hand.

• Check capillary refill every 15 minutes x 4, every 30 minutes x 2, every 1 hour x 4.

• The patient can sit in a chair and ambulate to go to the bathroom immediately after transfer to the holding area.

• Assess patient’s pain level, administer pain medications if ordered.

• Notify the physician if:

o Any problems arise, especially the presence of arm pain.

• Vigilance for the development of forearm hematoma associated with pain is extremely important. Accumulation of blood in the forearm can cause compartment syndrome and severe hand ischemia. Therefore, prevention is crucial. Notify the physician immediately and have elastic bandage or tape ready (ACE bandage or Elastoplast).

o Any uncontrolled bleeding (elevate the arm and apply manual pressure should this occur.)

o Circulation to the hand appears compromised.

• Removal of TR Band

o After approximately two hours, gradually deflate the device, 1 cc at a time, using the syringe provided in the kit. Remove 5 cc of air and observe the access site carefully for any bleeding. Then remove 5 cc of air every 15 minutes thereafter until the device is completely deflated.

o If bleeding occurs while deflating the device, re-inject 1 cc air until the bleeding stops and wait another 15 min before repeating the steps above.

o Once the TR band is completely deflated, confirm that bleeding has stopped, remove the device and place a protective covering (i.e.: band-aid, tegaderm, etc.)

• Assess perfusion to the hand (color, temperature, sensation) with vital signs.

• Instruct the patient about movement and activity restrictions. The dressing should be left intact until the next morning. The patient should minimize manipulation of the wrist for 24 hours. After the dressing is removed, the site may be gently cleansed with soap and water.