Ask the Clinical Instructor: A Q&A column for those new to the cath lab

Arlene, Good question. I had this same question myself and hadn’t researched it yet. I referred your question to the SICP Standards Committee and Ken Gorski, RN, RCIS, FSICP, committee chair and assistant manager, Sones Cardiac Catheterization Laboratories, The Cleveland Clinic Foundation. Here is the answer to your question: yes and no. It depends on a few different factors. First, it depends on the state in which you work. Some states will allow this and some will not, so finding that out would be the first step in determining whether you can access the artery. Next, it depends on your hospital. If you are in a state that allows you to access arteries, then you have to find out if your particular hospital allows it. Then, even if your hospital allows it, it is still up to your cath lab and the specific physician you are working with to decide if you can access the artery. Accessing the artery can look easy with skilled physicians, but there is a lot that goes into it. A safe stick is one that is in the lower two-thirds of the femoral head, below the ligament, and not too high above the bifurcation of the profunda and common femoral or too far below. Too high and you run the risk of retroperitoneral bleed, and too low runs the risk of pseudoaneurysm. Keep in mind that when you have larger patients, the crease where the leg meets the stomach cannot always be trusted as a stick spot. As we age and/or get older, the crease can move south. A method I use to place the drape in a good spot is one I learned from one of our physicians. Place the thumb of your left hand (if working on the right side) on your patient’s pelvic bone. Leave your thumb there, stretch your hand out and put your pinky finger on the pubic bone. Place your middle finger between these two fingers, and you should feel a pulse, if they have one. I do this because bony structures don’t move like skin and adipose, and you can be pretty confident that this is a decent stick site. Again, I want to stress arterial access looks easy because of skilled staff. Please don’t take this part of the procedure lightly and don't attempt this unless you have the ok. Still learning about the wide variety of patients that visit the cath lab? Could your question be one that others share as well? CLD can help. Submit your question to: Jason Wilson, RCIS at hrtfixr7 at yahoo. com

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