Authors (including presenting author) :
Li SC, Mak YM, Lee CH, So HM, Kwan YF
Affiliation :
Department of Intensive Care Unit, Pamela Youde Nethersole Eastern Hospital
Introduction :
Use of intra-arterial access is common in ICU for patient’s monitoring and treatment. Patients may have femoral arterial line due to difficult peripheral access. Femoral arterial sheath may be kept after angiographic procedures. Patient requires Intra-Aortic Balloon Pump (IABP) have arterial puncture for the IABP catheter. Furthermore, large pore vascular catheters are used in Extracorporeal Membrane Oxygenation (ECMO) therapy and inserted via arterial or venous approach. Although these catheters are removed by doctors to achieve hemostasis by manual pressure or application of “C-clamp”, delay post-catheter removal complications like bleeding, hematoma and bruise are sometimes occurred. This project aims to improve quality of patient care by reviewing the current practice and designing measures to facilitate early detection of the late onset complications.
Objectives :
To enhance the quality of patient care on Post Femoral Arterial/ECMO Catheter Removal Care.
Methodology :
Firstly, an electronic checklist was developed in Clinical Information System (CIS) and guided nurses to closely monitor for any delay complications. Secondly, the intensity of the nursing observations was increased from hourly to every 15 minutes for the initial 2 hours and then every hour for subsequent 22 hours including: monitoring patient’s vital signs, checking post puncture sites for bleeding and the affected limb circulation. Thirdly, communication with ward nurses upon patient’s transferal to general ward was enhanced with additional notes “Femoral Arterial Catheter Removal Date and Time, observe for Delay Bleeding” printed on hospital patient internal transfer checklist. Microteaching sessions and refresher training on proper use of “C-clamp” were conducted to all ICU nurses. Post implementation compliance checks were conducted for 2 times in September and December 2018 after one month and three months’ practice respectively. Episodes of complications after catheter removal were monitored.
Result & Outcome :
Post implementation evaluation on nurses’ compliance on the revised practice was improved. There were 50 patients involved. Total 14 % of patients (n=7) were observed to have post-catheter removal complications like bleeding, hematoma and bruise around ex-puncture site. Immediate nursing care was given and details were described as follows: 1. Bleeding was noted 30 minutes and 5 hours after catheter removal in two patients respectively and the bleeding was stopped by manual pressure. 2. One patient had serous oozing 6 hours after catheter removal, which subsided after 13 hours. 3. Bruise was noted in three patients and subsided gradually. 4. One patient had hematoma which subsided 2 hours later. Conclusions Complications associated with the removal of these catheters are detrimental. Intense nursing observations are vital to have early detection of late on-set bleeding complications. Sustainable compliance on the revised practice would be enhanced by periodic audit and checks to assure patient safety.
Co-location with:
