Overcoming vascular access problems Flashcards
What is the most frequently encountered difficulty in advancing guide catheters?
tortuosity of the iliac or subclavian vessels, oftenly found in elderly patients
What is the most commonly used equipment for tortuous vessels?
-Wholey 0.035 in steerable guide wire
-hydrophilic wire/guide Cath
-Long 300 cm exchange guide wires (regular/extra stiff)
-Long arterial sheaths from 23 cm to 90 cm
What does weak femoral pulses often indicate?
Atherosclerotic obstruction at the level of femoral, common iliac, or aortoiliac bifurcation.
When is access of sites with closed devices such as Angio seal thought to be safe?
2-4 weeks
Access of severly fibrotic or scarred groin with a femoral bypass graft may require what?
Dilation with a 5-8F dilator before inserting a vascular sheath one size smaller than the dilator.
improved outcomes of femoral pci removal includes? (3)
-Using smaller sheaths
-Discontinuing post PCI heparin infusions
-Removing sheath early
What are the steps for femoral PCI sheath removal?
-Adjust bed or use footstool
-Ensure IV access
-Give lidocaine to the skin around the sheath and IV analgesics before sheath removal
-Have atropine and pain medication available
-Check for ACT is under 150 secs, no chest pain, or recatheterization
-Remove arterial first if venous is also present
-Check leg and foot for cyanosis
-Hold pressure for 15 to 20 minutes depending on size of sheath, ACT, bleeding control
What is the most common complication from femoral cardiac cathetrization?
hemmorhage and local hematoma formation
When is a retroperitoneal hematoma suspected in a patient?
Hypotension, tachycardia, pallor, falling hematocrit pci, back pain, neurological changes in the leg with puncture
What is pseudo aneurysm a complication associated with?
Low femoral arterial puncture
What do you need to do if there is bleeding around the sheath?
upsize or remove
if left in place for a long period of time, what should you do with the sheath?
Replace long with short sheaths
What medicine do you give to reverse the anticoagulation of heparin?
Protomine
What should the standard be on a ACT before femoral sheath removal?
Under 180 seconds
Where should the operators hands be placed with femoral puncture site?
Above
