What Do You Think?

Multiple new and ongoing questions from readers. Your responses are welcome! Answer or pose a question at cathlabdigest@aol.com
Multiple new and ongoing questions from readers. Your responses are welcome! Answer or pose a question at cathlabdigest@aol.com

New Question!

Re: Bedrest and Discharge We are a new cath lab with our own pre/post holding area and are trying to figure out when to send our patients back to the telemetry unit after PCIs or home after diagnostic caths. Does anyone know if there are guidelines for how long a patient must be kept before being discharged after an outpatient diagnostic cath? How about the staff/patient ratio for inpatients after an intervention? Will this vary if a closure device is used? Also, is there any evidence-based information on bedrest times? Thank you! Mary Sue DeFeo, RN Email: Mary.Defeo@parrishmed.com Cc: cathlabdigest@aol.com

Answered!

Re: FemoStop Usage Please explain the standard of practice for FemoStop usage. I’m an experienced CCL RN with over 15 years of clinical experience. The standard of care I have learned to give is that FemoStop is not to be used for routine sheath pulling. I have only used it after manual compression where complications arose and extended compression was necessary. It has also been my experience that when the FemoStop is being used that close patient observation and monitoring is essential. FemoStop usage has always required a physician order for use in my practice. I’ve heard feedback arguing that sheath pulling causes carpal tunnel syndrome. That also has not been my experience. Proper technique in pulling sheaths and groin management is essential for safe and successful outcomes for both the patient and the clinician. I look forward to your feedback. Susan Andrews Email: susan.andrews@provena.org Cc: cathlabdigest@aol.com Dear Susan, At our institution, Geelong Hospital, in Victoria, Australia, we use the FemoStop for standard sheath removal for both diagnostic caths 4F to 6F and PCI sheaths 6F and 7F as standard care. You can visit http://www.cathlabdigest.com/images/fa.pdf to download a PDF document detailing arterial sheath removal using the Femostop and the Wilson technique in our wards and labs. This technique was developed by Lynne Wilson, who undertook a study on arterial sheath removal and hematoma formation. She found that hematoma rates were decreased using this technique rather than the manufacturers’ guidelines. We have been using this technique now for over 12 years with success measured by a very low hematoma rate (consistently lower than the 4% rates noted in the literature.) We keep quality data on every patient. Please note that arterial diagnostic sheaths are removed immediately without premedication, provided the heparin dose does not exceeded 2,000 units. Where higher doses of heparin are administered, an ACT is taken, and if
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