Vascular Site Management and Complications
A mass of clotted blood that forms due to a broken blood vessel and manifests as swelling and localized pain.
Hematoma
True or False: Nurses on 9ST are allowed to reapply an RCD once it has been removed.
False
List the two times when a Reverse Barbeau test needs to be performed and charted by the RN.
On handoff from the procedure unit and one hour after removal of radial compression device.
Where does the nurse go to determine the length of time that a Safeguard or Femostop should be in place and inflated?
You orders. Call for clarification if they are not placed.
List two resources for vascular management questions.
Policy tech, charge nurse, 10S charge, Lippincott, Alicia, 9ST leaders, procedural provider (fellow or NP).
In addition to monitoring vital signs, what is the nurse assessing for with each vascular site check? (List at least three things)
Pulse, Firmness/tenderness, temperature, numbness/tingling, hematomas, color/mottling
How often are assessments performed while the TR band is in place?
Every 15 minutes the entire time the TR band is on
What grading requires immediate provider consultation for intervention.
Grade D.
How often are site assessments performed while a femostop is in place?
q15 x 4, q 30 x 2, then hourly until the device is removed
True or False: Application of a sandbag is an evidence-based technique for managing vascular complications.
False
Signs and symptoms of this complication include flank, abdominal or back pain, unexplained hypotension, sudden urge to void or move bowels, or development of an abdominal mass
Retroperitoneal Bleed
What dressing type is removed after 24 hours utilizing water/saline?
Softseal Hemostasis Pad
Document a Reverse Barbeau in Epic for a loss of pulse tracing followed by recovery
Pulls up Epic, goes to cath lab flowsheets, scrolls down to Barbeau test. Documents under post procedure and radial. Gives Grade C
Where should the transparent dome be located when placing a femostop?
One inch above the puncture site
For active oozing or bleeding after a femoral arterial sheath procedure (TAVR), where should the nurse place pressure?
1 inch above the vessel puncture site using downward pressure.
Initial treatment for a hematoma includes:
Hold direct pressure over the site with three fingers, elevate the extremity, and call the provider. Measure and outline the hematoma with a skin marker.
When hemostasis pad is present, how quickly can air be removed from the TR band?
Over 5 minutes.
Describe what inadequate collateral flow from an overinflated RCD or thrombus will look like on pulse tracing during the reverse barbeau.
A flat line
How quickly is pressure released from the femostop device once it is time to remove?
10-20 mmHg every 2-3 minutes
For active oozing or bleeding after a femoral venous sheath procedure (TMVR, TTVR), where should the nurse place pressure?
Downward pressure directly over the puncture site.
What team should be immediately notified if the nurse identifies a diminished/absent pulse, coolness, pallor, or paresthesia on assessment?
Ischemic limb team at '22' - concern for arterial occlusion
Demonstrate the appropriate technique for removing a TR band
Live demo - keeps finger on the end of the plunger, correctly re-inflates with amount of air just removed when bleeding occurs.
Demonstrate a Reverse Barbeau Test
Compress the ulnar artery and observe for changes. Do not compress for more than 2 minutes. When the ulnar artery is manually occluded, the waveform displayed demonstrates patency through the radial artery.
Demonstrate correct placement of a femostop with 40mmHg.
Demonstration includes properly placing belt evenly under the hips, threading belt into sidearms. Leave room for a finger fit in between. Remove protective lid from dome, and place dome one inch above the puncture site. Inflate to 40 mmHg.
Locate and 'favorite' the ASLMC policy with your resources for vascular management
Search ASLMC Sheath Removal Guidelines