Femoral Sheath Removal Research Articles

Is lidocaine infiltration during femoral sheath removal really necessary?

OBJECTIVES: To compare the effectiveness of intravenous morphine sulfate to intravenous morphine sulfate plus 1 % lidocaine infiltration in pain management associated with femoral sheath removal, and to evaluate pain intensity and associated complications during femoral sheath removal in patients with heart disease receiving interventional treatment. DESIGN: Descriptive, correlational, case-control study. SETTING: Mid-metropolitan, university-affiliated, tertiary care medical center. SAMPLE: Fifty patients with heart disease, who had no known allergies to morphine or lidocaine and who had not had an acute myocardial infarction, admitted to the cardiovascular intervention unit. MEASURES: Vertical visual analogue scale, short-form McGill Pain Questionnaire, and demographic tool for complications. RESULTS: No significant differences in pain intensity, sensation, affect, and total scores were found between the analgesic regimens. Six (12%) patients had vasovagal reactions develop, but no statistical differences were found between pain intensity scores and associated complications. CONCLUSION: Morphine sulfate does appear effective in controlling pain associated with femoral sheath removal. The benefit of lidocaine infiltration during this procedure is questionable.

Periprocedural routines of coronary angioplasty--extreme diversity with unrevealed consequences.

Our objective was to evaluate the current trends of coronary angioplasty periprocedural care in the state of Israel. PTCA technology has undergone through some major developments and refinements, which have yielded new algorithms and routines. With this shift of paradigms, some of the periprocedural routines (these include medications and dosing before, during and after the procedure, as well as the handling of anti-coagulation, femoral sheath removal and the extent of patient monitoring post-PTCA) have been partially re-established. In order to assess trends in periprocedural care, we elected to analyze the current state of practice in the state of Israel. A questionnaire was sent to every cardiac catheterization laboratory in Israel that performs PTCA. An authorized senior cardiologist representing the laboratory submitted the information required for our survey. A nurse-to-nurse telephone questionnaire was conducted simultaneously to cross-examine the validity of the data. All centers submitted results. The average heparin dose for PTCA varied between 5000 and 15 000 units, ACT was monitored routinely by some and not at all by others, post-PTCA heparin administration was routinely administered by some institutions and not by others, and the mean femoral sheath dwell time ranged from 4 to 18 h. Post-PTCA cardiac monitoring varied from 6 to more than 24 h. Some institutions prescribed to all patients nitrates, calcium channel blockers and low-molecular-weight heparin, while others did not. We conclude that there is profound variability in the periprocedural routines that may translate into a significant cost increase, patient discomfort, a prolonged monitoring and hospital stay, and potential patient morbidity. We suggest that these routines should be critically evaluated, and that if they do not contribute to the procedural success and patient well-being they should be abandoned.

In-Laboratory Removal of Femoral Sheath Following Protamine Administration in Patients Having Intracoronary Stent Implantation

Two hundred twenty-eight patients with successful coronary stent implantation were randomized either to protamine administration and femoral sheath removal (group I, n = 117) or no heparin neutralization and delayed sheath removal (group II, n = 111). The hospital stay after treatment was shorter in patients receiving protamine; therefore, protamine use for neutralizing circulating heparin may be safely administered immediately after stent implantation.

Removal of femoral sheaths by registered nurses

Removal of femoral sheaths by registered nurses

Removal of femoral sheaths by registered nurses: issues and outcomes

The results of this evaluation indicate that specially trained critical care nurses can remove femoral sheaths with an acceptable margin of safety. As a result, these nurses can provide quality, cost-effective care to angioplasty patients. However, before this procedure is included as part of the RN's responsibility, written protocols are needed to identify appropriate patients, proper removal technique, and specific actions to take if complications occur. In addition, plans must be developed for initial education and ongoing competency evaluation to ensure that each nurse involved maintains an adequate knowledge base and skill level.

Assessing patient comfort: local infiltration of lidocaine during femoral sheath removal

Patient comfort is a primary nursing concern when removing femoral sheaths. The use of lidocaine infiltration, a common practice at our facility, was not addressed in the reviewed literature. To assess and evaluate the level of patient comfort and efficacy of lidocaine hydrochloride as a local anesthetic during femoral sheath removal and application of a compression device. A literature search and telephone interviews were conducted with nurses and technicians who removed or assisted with the removal of femoral sheaths in 13 hospitals in the United States. Three patient comfort indicators were then developed and used for data collection. Over a 12-month period, nurses in the cardiology interventional unit removed the femoral sheaths without the use of lidocaine from 111 angioplasty/arthrectomy patients and evaluated the level of patient comfort. A literature search provided no information that supported the use of lidocaine hydrochloride infiltration during sheath removal. Telephone interviews showed that six of the hospitals used lidocaine as standard procedure and seven did not use lidocaine at all. Of the evaluated patients, 105 (94.59%) reported comfort during sheath removal without local infiltration of lidocaine. Our results supported the premise that patients do not require lidocaine before sheath removal to maintain an acceptable level of comfort.

902-7 Ultrasound Guided Coronary Stent Placement without Prolonged Systemic Anticoagulation

Over a five-month period, 83 consecutive patients undergoing elective Palmaz-Schatz stent placement in a target vessel of greater than 3.2 mm in diameter were evaluated for early hospital discharge without anticoagulation. Thirty-nine patients failed to meet angiographic or clinical criteria due to the presence of dissection (11 patients), TIMI flow < 3 (11), filling defects (7), a persistent angiographic stenosis (6) or stent placement in sole-remaining circulation (4). The average final balloon size after stent placement was 4.5 mm (range 3.5 to 6.0 mm) and minimal luminal diameter within the stent was 3.75 mm (range 3.0 to 4.0 mm). In the remaining 44 patients, intravascular ultrasound (IVUS) was performed after a definitive angiographic result had been obtained to determine if previously established criteria (stenosis, apposition and symmetry) for discharge without anticoagulation had been fulfilled. Twenty-one patients (77%) met criteria after the initial IVUS evaluation and six (23%) after reinflation with larger balloons. Seventeen patients failed to meet IVUS criteria: 14 due to a persistent area stenosis of > 15%, one who lacked apposition in an aneurysmal segment, one with an angiographically occult dissection and one who achieved < 60% of the reference vessel cross-sectional area. Of the 27 stents meeting IVUS criteria, mean eccentricitywas 0.86 (range 0.75 to 0.98), residual stenosis was -0.8% (range -31 to 15%) and minimal stent diameter 3.82 mm (range 3.0 to 5.0 mm). One patient met angiographic and IVUS criteria but received prolonged anticoagulation due to preference of the referring physician. Mean elapsed time from stent placement to femoral sheath removal was 8.2 hours (range 1 to 29 hours). Patients were discharged from the hospital within 48 hours of stent placement, all receiving aspirin 325 mg per day and ticlopidine 250 mg twice a day. At 30 days of clinical follow-up, no patients experienced stent thrombosis. In this highly selective group of patients undergoing elective stent placement in larger diameter vessels who fulfilled strict clinical, angiographic and IVUS criteria, early discharge on aspirin and ticlopidine without systemic anticoagulation was not associated with stent thrombosis.

Effect of Analytic Uncertainty of Conventional and Point-of-Care Assays of Activated Partial Thromboplastin Time on Clinical Decisions in Heparin Therapy

The authors assessed the capability of assays of activated partial thromboplastin time (aPTT) for supporting clinical decision algorithms for heparin therapies of varying complexity. Blood samples were collected prospectively in three explicit management strategies from 100 sequential patients for whom heparin dosage was adjusted for therapeutic monitoring, femoral venous sheath removal after cardiac catheterization, or heparinization after thrombolytic therapy. In two- and three-way decision algorithms, conventional and point-of-care aPTT assays agreed with heparin assays in approximately two thirds of cases, and the two aPTT assays agreed in 80% or more of all cases. In six-way decision algorithms, the two aPTT assays agreed in only about half of all cases. The authors conclude that the reliability of point-of-care aPTT assays is similar to that of conventional assays. Both techniques can support two- and three-way decision algorithms but not some more complex patient classifications.