Radial site
What is the first thing you should assess when the patient arrives to the floor from cath lab?
The radial site - CMS check, wave form on pulse oximetry
Can your patient take a bath tomorrow after a pacemaker?
NO! No submerging in water for 1 month.
What is the first thing you do when you discover a hematoma?
Apply manual pressure!
What are lifestyle modifications you should recommend?
Diet, exercise, smoking cessation, medication compliance
Your patient goes into new a-fib. What are the two drips that the doctor might consider ordering to help control their rate/rhythm?
Amiodarone and Diltiazem
What are you going to educate your patient to do upon arrival to the floor in regards to the new procedure site?
Treat wrist like a sprain, elevate on pillow, keep arm board in place, notify RN if any bleeding, sensation changes or pain.
Your patient goes back into a-fib after an ablation. Is this considered a failed ablation?
Not necessarily. It can take time for the scar tissue to form from the procedure.
Where to find the sheath pull protocol based off of ACT?
The link in the kardex.
Where on 2East can you find patient education? And what education would you consider giving the patient post MI?
Education room right off of breakroom and family waiting area. MI folders consist of education on angioplasty pathway (radial and femoral), stents, nitro, heart healthy diet, antiplatelet medication, modifiable vs non-modifiable risk factors.
In case something is wrong with the lead placement or patient develops a pneumothorax which is why we do a chest x-ray and interrogation the next morning.
When do you start to remove air out of the hemoband if they received therapeutic heparin and hemostasis was 1500?
1700
How would you properly place a pressure dressing on a hematoma from a pacemaker?
Place kerlix on top of hematoma site and then dress with foam tape across one side of the body in a X formation - about 3 pieces each side.
What are possible sheath pull complications?
Pseudoaneurysm
Retroperitoneal bleed
Hematoma
Vasovagal
Vascular complications
Why is it important to get an EKG post procedure?
This way if patient develops chest pain after intervention then cardiology can review EKG from right after to the new one and assess if there are any changes.
Why would a watchman be recommended for a patient?
Chronic a-fib and high risk for falls or bleeding - there is a special scoring system that cardiology uses.
What are the possible complications from radial access?
Hematoma, pseudoaneurysm, compartment syndrome, limb ischemia
What is the difference between radiofrequency and cryothermal?
Heat vs ice
What are the two tools you can use with groin management?
Femstop - hematoma that is not resolved with manual pressure
Safeguard - concern for hematoma ie. coughing, wiggling, previous oozing/hematoma that has now resolved
What defines an MI?
Elevated troponin, EKG changes, Chest pain/other symptoms of MI
What does the patient get done after a TAVR is placed?
Echo and EKG the next morning.
What are possible interventions you would consider an MD to have you do when a hematoma develops above the hemoband site/forearm?
What is the difference between dual chamber vs bi-ventricular pacemakers?
Dual Chamber - Right atrium and right ventricle
Bi-ventricular - Both right and left ventricle
You are getting ready to pull a sheath. What supplies do you need and talk through what steps you take to pull it.
Supplies: Sheath pull kit, atropine, IV fluids, Quick clot, Tagaderm, Doppler (ultrasound gel, foam tape), second RN
First make sure vital signs are stable and patient has voided/received any pain interventions. Place doppler on pedal pulse. Next open up sheath pull kit and begin to remove tagaderm from patient and clean around sheath with solution of 1/2 NS and 1/2 Hydrogen peroxide with gauze. Then clean with the Chlorhexidine wand around sheath site. Next pull back 10 cc of blood from sheath to remove any potential blood clots. Then grab your quick clot and place directly above sheath and assess how much pressure will be needed to fully occlude pulse by listening to doppler. Then remove suture with knife in kit. Finally set vital signs to run Q2 min, have quick clot ready and remove sheath. Hold pressure for length of time per protocol.
What are the medication classes you will typically see a patient on after an MI?
Antiplatelet, Beta blocker, Ace/ARB, Aspirin, PRN Nitro, Statin
You review am medications for a patient going to cath lab this morning. The patient is on Aspirin, Plavix, Eliquis, Lasix, and Metoprolol. Which medications would you hold?
Eliquis - Always hold DOAC's because of risk for bleeding.
Lasix - You don't want patient voiding during the case.