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While caring for a patient who underwent a percutaneous transluminal coronary angioplasty (PTCA), the nurse prepares to remove the femoral sheath. The heparin infusion was stopped 4 hours ago and there appears to be no evidence of bleeding from the insertion site. In order to prevent bleeding complications, the nurse will pull the sheath when the activated partial thromboplastin time (aPTT) is

Explanation

• After a myocardial infarction, a PTCA is often done. A sheath is inserted in the femoral or radial artery to allow thin wires to pass through to the coronary arteries and a balloon-tipped catheter pushes the plaque against the wall of the vessel, widening the lumen of the artery and restoring perfusion to the heart.

• aPTT is a lab value that estimates how long it takes (in seconds) for blood to clot. Heparin infusions are titrated based on aPTT values. The higher the aPTT value, the longer it will take blood to clot (and the higher the risk for bleeding).

• Heparin is often infused to prevent further thrombogenesis. Although lab reference ranges will vary, Mosby's normal value ranges for this test are 30 to 40 seconds. The aPTT should be 40 or less before the nurse can remove the femoral or radial sheath that was used for the procedure.

•Pressure is usually manually applied by the nurse for 15 minutes after removing the sheath to prevent bleeding/hematoma formation. Sandbags or other pressure dressings are usually applied after 15 minutes of manual pressure has been completed.

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