This is a little bit technical for most, but not all of the readers. In this community, it is an issue of huge import. How many people have had, or know someone that has had a cardiac cath?
With the poor diet (when told they have to cut fried foods from their diet, the comment is "What can I cook?"), combined with the decreased physical activity levels, obesity, and smoking, this area is heart attack central.
Apparently, the entire staff of the Cath Lab threatened to walk out last week. I don't know their issues (besides staffing, call, and flexing), but I would certainly entertain them in this forum.
I don't know if the person that commented on this topic is a current employee, or former, just that he/she appears knowledgeable and is timely. Some of the earlier comments can be found here.
Ok, back to the 9fr holes. During any intervention in the cath lab, the pt. receives blood thinners, heparin etc... The sheath can't be pulled until the blood is thick enough to pull the sheath, as determined by the ACT. This is several hours after the intervention. Therefore, the sheaths are pulled by trained nurses. They are pulled in the cath lab by a nurse or a tech, if an intervention was not done.
Other variables come into play here as well. The patient has been given versed and fentanyl during the cath, to ease the pain and anxiety during this procedure.
They are told to lie flat for x amount of time, to hold pressure on the site if they cough, and other instructions to help prevent re-bleed from this site.
But wait a min. They have been given versed and fentanyl. It makes you forget and not care. They are forgetting to hold their head down, coughing, and not holding pressure on the site.
This is where it is so important to have good staffing. They are told to get on the call light if they the site starts bleeding, or if it starts swelling or hurting. The site is supposed to be checked on every 15 min.
So, if someone is not answering call lights, if the nurse is giving blood, or in a code etc... and there isn't another to check it, yes some one could bleed to death very easily. That is a big artery, with a big hole.
Staffing is so important. It is the most important issue related to the heart program, and if Essent is not going to take that seriously, then we should not have it.
I "think but don't know" for sure that the nurses and tech's pull sheaths pretty much everywhere. I think this is common practice.
Another problem along the lines of this same issue, is floating (staff). If you float a knowledgable ER nurse to the stepdown unit, or ICU, and they have a patient with a sheath, or a post cath. Do you think they are gonna have a clue what to do in case of a problem?
If things are so bad that they have to float ER staff to these areas, do you think that there is going to be someone with time to help that ER nurse deal with a sheath problem?
It spells death. It spells law suit. It spells eternal guilt for someone.
I'm telling you guys, staffing, and appropriate staffing, and acuity is a huge problem.