The FemoStop compression device: utilization guidelines for the critical care nurse

FemoStop is an exciting new femoral compression device being used on patients by critical care nurses. It is now common practice in many settings for the nurse to remove post-angioplasty and post-cardiac catheterization sheaths. In settings where physicians are primarily removing these devices, nurses must then be prepared to deal with site bleeding, post-sheath removal. FemoStop provides a means to do this. An understanding of the utilization guidelines for this product is beneficial and timesaving for busy nurses in many settings.

Postcardiac catheterization time-in-bed study: enhancing patient comfort through nursing research

Cardiac catheterization has become a routine diagnostic procedure. Little has been written about standards for nursing care related to bed rest postcatheterization. The purpose of this experimental study was to determine whether there was a significant difference in incidence of bleeding from catheter insertion site between those patients who remained in bed for 12 hours and those who remained in bed for 6 hours post-procedure. There was no significant difference between the two groups. Postprocedure bed rest was reduced from 12 to 6 hours in this tertiary care medical center. Decreasing time in bed reduced cost and patient discomfort.

Bleeding complications in the patient with cardiac disease following thrombolytic and anticoagulant therapies

Thrombolytic and anticoagulant therapies are used frequently in the cardiac patient. Bleeding complications and other coagulation defects, such as heparin-induced thrombocytopenia (HITP), can occur following the administration of these drugs. Nurses caring for the cardiac patient need to be aware of the potential for bleeding and know how to safely and effectively care for the patient who experiences a bleeding event.

The antiplatelet effects of aspirin and related component drugs on the surgical patient

Any medication has potential to cause adverse side effects. Some medications prescribed for a specific function are also widely available as over-the-counter products to treat menstrual discomfort, colds and allergies, or they may act as sedatives. For example, aspirin (ASA), medications that contain ASA, and nonsteroidal anti-inflammatory drugs all have antiplatelet properties. The surgical patient who regularly uses these medications may potentially develop postoperative hemorrhage.

Effectiveness of nursing involvement in bedside monitoring and control of coagulation status after cardiac surgery

OBJECTIVE

This study explores: (1) the feasibility of involvement of nursing staff in routine bedside testing of activated clotting time and (2) joint implementation with resident medical staff of a preformulated plan for management of mediastinal bleeding after cardiac surgery.

DESIGN

Patients were divided randomly into two groups, an experimental group (n = 108) subjected to ACT testing and management by protocol, and a control group (n = 146) treated by independent medical decisions.

RESULTS

Bleeding, volume of blood replaced, abnormal coagulation profiles and reoperations to control bleeding and its consequences were all reduced in the study group.

CONCLUSION

We concluded that bedside measurement of activated clotting time by nursing staff, associated with therapy based on a flow diagram, enhanced the overall management of early mediastinal bleeding after cardiac surgery as compared with independent management decisions by resident medical staff. In addition, the method provided a sensitive and reliable means of detecting and correcting rebound heparinization in the early postoperative period.

Hidden problems with bleeding in trauma patients

Clearly, the reasons for the blood loss of the patient described herein were multifactorial. In addition to the scalp and perineal lacerations, she had multiple bone fractures. Her hypothermic condition, head injury, and acidotic state were factors that could lead to coagulopathies. Lastly, multiple transfusions may have exacerbated the above problems both by hemodilution and further decreasing core temperature. Caring for patients like this one is a challenge to the trauma team and requires expert knowledge to anticipate, identify, and treat the wide variety of potential complications that can contribute to bleeding.