Q We are reviewing our policy and procedures on arterial and venous sheath removal after percutaneous coronary intervention (PCI). What is the proper activated clotting time (ACT) at which to remove a femoral sheath after PCI? What are the best “protocols” for sheath removal?

A Annmarie Galli, rn, bsn, mba, and AnneMarie Palatnik, msn, apn, bc, reply:

The number of PCIs continues to increase each year. Balloons, stents, and drug-eluding stents have proven effective in treating plaque blockages in coronary vessels. Although the rate of ischemic complications continues to diminish after PCI, bleeding complications are still common.

The most bleeding associated with PCI occurs at the femoral artery access site.1 Recent research has shown that bleeding complications are more serious than previously thought, and it is important that clinicians make all efforts to reduce bleeding after PCI.2 Reaching hemostasis after sheath removal...

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