Venous and Arterial Sheath Pulls

Venous and Arterial Sheath Pulls

Reference SOP: EC5.M8 in Policy Tech

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Supplies & Equipment

• Sterile 10 ml syringe
• Sterile 4x4 gauze
• Sterile gloves
• Sterile Tegaderm or Bio-Occlusive dressing
• Appropriate PPE

Pre-Removal Preparation

• Confirm ACT level if anticoagulated (per physician)
• Maintain sterility of access site
• Remove dressings/sutures securing sheath
• Attach syringe to side port and withdraw 5–10 ml blood
• Check for clots in syringe (handle with care if present)

Pre-Removal Preparation

• Confirm ACT level if anticoagulated (per physician)
• Maintain sterility of access site
• Remove dressings/sutures securing sheath
• Attach syringe to side port and withdraw 5–10 ml blood
• Check for clots in syringe (handle with care if present)

Sheath Removal Technique

• Position fingers near puncture site (proximal for arterial, distal for venous)
• Withdraw sheath slowly and steadily
• Apply manual pressure while ensuring distal pulses remain palpable
• Monitor vital signs every 5 minutes during pressure hold

Manual Pressure:

• Duration:
• Arterial: ≥ 20 minutes
• Venous: ≥ 10 minutes

• Larger bore/groin sites: may need more time

• Apply sterile dressing after hemostasisFollow physician-specific site management orders

⚠️ Call Provider If You See:

• Rapid swelling or bruising at the site (possible hematoma or bleeding)
• Pulsatile mass or bruit (suggests pseudoaneurysm or AV fistula)
• Ongoing bleeding despite pressure
• No distal pulse or cold, pale limb (possible thrombosis or embolism)
• Severe pain at or near the site
• Bradycardia and hypotension (vasovagal response)
• Signs of infection (redness, warmth, drainage, fever)
• Chest pain or neurological changes (possible embolic event)
• Unstable vital signs (especially hypotension or hypertension)