Venous and Arterial Sheath Pulls

Venous and Arterial Sheath Pulls

Reference SOP: EC5.M8 in Policy Tech

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

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

Withdraw sheath slowly and steadily

Position fingers near puncture site (proximal for arterial, distal for venous)

Monitor vital signs every 5 minutes during pressure hold

Apply manual pressure while ensuring distal pulses remain palpable

Apply sterile dressing after hemostasisFollow physician-specific site management orders

Duration:Arterial: ≥ 20 minutes Venous: ≥ 10 minutes Larger bore/groin sites: may need more time

⚠️ 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 siteBradycardia 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).