Capping Arterial Sheaths in Patients Undergoing Percutaneous Coronary Intervention: Evidence-Based Practice

Percutaneous coronary intervention (PCI) is widely used in the treatment of patients with symptomatic coronary artery disease. Originally, the femoral arterial and venous sheaths used in the procedure were left in place overnight to keep heparin infusing and blood flowing through the angioplasty site. In order to maintain patency of the sheaths and monitor for their disconnection, routine practice at Hospital of the University of Pennsylvania was to connect the arterial sheath to a transducer with a heparinized (500 IU of heparin in 500 mL of isotonic sodium chloride solution) and pressurized (200–300 mm Hg) flush device. With the use of new platelet-inhibiting medications, the care for these patients changed. Instead of being left in overnight, the arterial and venous sheaths were removed when the activated clotting time was less than 180 seconds (approximately 2–4 hours after the procedure),...