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Maintenance and Care of Neuroendovascular Femoral Arterial Sheaths (6.18)

Maintenance and Care of Neuroendovascular Femoral Arterial Sheaths (6.18) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Neurologic

6.18

NURSING PATIENT CARE POLICY & PROCEDURE





Effective Date:
March 18, 2016

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 6.18A

Original
Revision

Page
1
of 3

Title: Maintenance and Care of
Neuroendovascular Femoral Arterial
Sheaths (Adult)

I. PURPOSE

To outline maintenance and care for a neuroendovascular arterial sheath that has
been placed in the common or superficial femoral artery. This procedure only
applies to the use of heparin infusions into the femoral arterial line, not the use of
other anticoagulation drugs.

II. POLICY

Placement of the femoral/arterial sheath is performed/supervised by the
neuroendovascular attending physician in the neuroangiography suite. Registered
nurses who have completed the competency for setting up the transducer and
maintenance of the femoral sheath will be responsible for the maintenance of the
transducer and sheath as ordered by the neuroendovascular attending physician.

For patients with heparin sensitivities or where use of a blood thinner is
contraindicated, normal saline without heparin will be used. A formal hematology
consult will be up to the discretion of the neuroendovascular attending physician.

III. INDICATIONS FOR LONG-TERM ARTERIAL SHEATH PLACEMENT
FOR NEURO INTERVENTIONAL RADIOLOGY

Indications include maintaining a sheath for follow-up angiographic procedures
where repeated access is difficult (due to anatomic or atherosclerotic reasons) or
when the patient requires frequent (i.e., daily) interventional procedures.

IV. RELATIVE CONTRAINDICTIONS

A. Significant peripheral vascular disease
B. Vascular grafts/prosthetics
C. Clots around sheath
D. Heparin sensitivity or contradiction to using a blood thinner

V. POTENTIAL COMPLICATIONS

A. Partial or total loss of circulation to the extremity
B. Bleeding or hematoma
C. Air embolism or thrombosis
D. Hemorrhage

Page 2 of 3

E. Infection
F. Pain
G. Nerve damage

VI. EQUIPMENT

A. Alaris® System Programming Unit
B. Alaris® System Large Volume Pump (LVP) module
C. Alaris® tubing set
D. Tubing labels
E. 1000 units heparin in 500 mL fluid labeled appropriately
F. 1 liter normal saline (if heparin is contraindicated)
G. Cell saver transducer or arterial line kit

VII. PROCEDURE

A. Review the patient’s chart as necessary and call neuroendovascular team for any
questions.
1. Indications as noted in section III above will be the only reason for the
use of this procedure.
B. Perform hand hygiene according to UWHC Hospital Administrative Policy
13.08, Hand Hygiene.
C. Place a label on the designated Alaris® System pump stating “STRICTLY FOR
ARTERIAL USE ONLY”. Do not place this pump on the same pole as the
Alaris® pump used for intravenous infusions.
D. Set the IV pump pressure at 500-525 mm Hg.
1. Press CHANNEL SELECT key on the LVP module
2. Press the OPTIONS key
3. Press either PUMP or SELECTABLE pressure soft key. If
SELECTABLE is pressed, continue with the next step: otherwise,
proceed to the last step.
4. To select the occlusion pressure limit, press either the UP or DOWN
key.
5. Verify the occlusion pressure limit and press CONFIRM soft key.
6. Press START soft key.
E. The transducer from cell saver or arterial line kit is used and labeled as an
arterial line. Cap off all access ports so no other medications can be given
through this line.
F. When using heparin, make sure the heparin bag is labeled 1000 units per 500
mL. Following independent double check per UWHC Hospital Administrative
Policy 8.33, High Alert Medication Administration.
G. Prime the tubing with the heparin bag; make sure there are no air bubbles in the
line.
H. Program the Alaris® pump at the rate ordered by the physician (usually 30-50
mL/hour).
I. Remove the pigtail of the transducer or flash flush device and replace with a
blue end cap.
J. Place the transducer onto the most distal port of the IV tubing.
K. Close off the femoral sheath to the patient.

Page 3 of 3

L. Carefully watching that no air is introduced, connect the heparin line to the
femoral sheath.
M. While keeping the sheath turned off to the patient, set up the transducer with the
monitor. Reference Nursing Patient Care Policy 1.11, Arterial
Catheter/Insertion, Maintenance, Blood Drawing and Discontinuation.(Adult &
Pediatric)
N. Turn the sheath on to the patient and turn on the pump.
O. Check to make sure the wave form from the transducer is good.
P. Label pump tubing at each connection (both ends) “FEMORAL LINE -
ARTERIAL USE ONLY - NO MEDS”.
Q. When changing the dressing the site is cleaned with chlorhexidine followed by
placement of a Biopatch,® the dressing should be changed with each
neuroendovascular procedure and in adherence to UWHC Nursing Patient Care
Policy 1.11, Arterial Catheter/Insertion, Maintenance, Blood Drawing and
Discontinuation (Adult & Pediatric). This should be done by a
neuroendovascular physician or ICU nursing staff.
R. Assess and document the site check every hour. Assess and document
circulation/motor/sensation and site checks every four hours after the initial
angio checks are done.
S. Keep the patient’s leg straight and head of bed at less than 30 degrees. The
patient cannot get out of bed for any reason.
T. Document in Lines/Drains/Airways. Add column/line for catheter sheath
arterial. Document the site, hematoma management and sheath status.
U. Removal done by provider only.

VIII. UWHC CROSS REFERENCES

A. Alaris System® Directions for Use Manual, pp. 2-73 & 2-74 (See Alaris®
System website on U-Connect)
B. Hospital Administrative Policy 8.33, High Alert Medication Administration
C. Hospital Administrative Policy 13.08, Hand Hygiene
D. Nursing Patient Care Policy 1.11, Arterial Catheter/Insertion, Maintenance,
Blood Drawing and Discontinuation (Adult & Pediatric)

IX. REVIEWED BY

Nurse Manager, Neuro ICU
Clinical Nurse Specialist, Neurosurgery
Nursing Patient Care Policy and Procedure Committee, March 2016

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services, Chief Nursing Officer