Arterial and Venous Sheath Removal
PREREQUISITE NURSING KNOWLEDGE
• Knowledge of the femoral artery and vein anatomy is important.
• The technique for the percutaneous approach to the insertion of the arterial and venous sheaths should be understood.
• Technical and clinical competence in removal of arterial and venous sheaths is needed.
• Knowledge about anticoagulation and antiplatelet therapy used during interventional procedures is essential.
• Understanding of the technology (i.e., activated clotting time [ACT] machine) used to determine the timing of arterial sheath removal and knowledge of the institution’s standards regarding removal of arterial sheaths are important.
• The importance of peripheral vascular and neurovascular assessment of the affected extremity (e.g., assessment of the quality and strength of the pulse to be accessed and the pulses distal to the access site, assessment for a bruit) should be understood.
• Knowledge about the variety of hemostasis options available should include the following:
Manual compression alone or in combination with noninvasive hemostasis pads (e.g., Syvek Patch, Marine Polymer Technologies, Inc, Danvers, MA; Clo-Sur P.A.D., Scion Cardio-Vascular, Inc, Miami, FL; D-Stat Dry, Vascular Solutions, Minneapolis, MN).
Mechanical compression devices (e.g., CompressAR, Advanced Vascular Dynamics, Portland, OR; FemoStop, Radi Medical Systems, Wilmington, MA; Fig. 77-1).
• Collagen plug devices, percutaneous suture-mediated closure devices, and percutaneous staple-mediated closure devices can be deployed into the artery by the physician at the end of the catheterization or interventional procedure.
• Sheath removal can be associated with many complications, including the following:
EQUIPMENT
PATIENT AND FAMILY EDUCATION
• Explain the procedure to the patient and the family. 
Rationale: This explanation provides information and may help decrease anxiety and fear. This also encourages the patient to ask questions and voice concerns about the procedure.
• Explain the importance of bed rest, of not lifting the head off the pillow, of maintaining the head of the bed at no higher than 30 degrees, and of keeping the affected extremity straight for a specified time to maintain hemostasis after the procedure. 
Rationale: The patient is prepared for what to expect after the procedure, and patient cooperation is elicited to decrease the risk for bleeding, hematoma, and other vascular complications.
• Explain that the procedure may produce discomfort and that pressure will be felt at the site until hemostasis is achieved. Encourage the patient to report discomfort, and reassure the patient that analgesia and or sedation will be provided. 
Rationale: Explanation prepares the patient for what to expect and allays fears.
• After sheath removal, instruct the patient to report any warm, wet feeling or pain at the puncture site. Also, instruct the patient to report any sensory or motor changes in the affected extremity. 
Rationale: This aids in the early recognition of complications and identifies the need for additional pain interventions.
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29: Arterial-Venous Oxygen Content Difference and Oxygen Transport (Delivery) and Consumption Calculations
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