1. Balerno, Lora N. MSN, RN-BC, CCRN
  2. Michel, Lisa RN
  3. Davis, Diane RN
  4. King, Sherry RN
  5. Lizardo-Mitchell, Emily RN
  6. Scheimann, Diane RN
  7. Ryan, Twyla RN
  8. Robinson, Rebecca RN
  9. Hale, Jane RN
  10. Beavers, Sandra RN
  11. Mashewske, Tamara RN

Article Content


The objective of this study was to investigate nurses' and patients' comfort level/satisfaction using the manual assist technique (MAT) with the Safeguard compared with use of the FemoStop during femoral arterial sheath removal postcardiac catheterization (with/without coronary intervention).



Through literature review and performance improvement analysis, CICU nurses validated the safety of manual pressure or use of FemoStop in sheath removal. However, limited information on patients' comfort level associated with AV-sheath removal existed. Pain (from exertion of pressure on the groin) can precipitate a vasovagal response. Intradermal lidocaine may be used to reduce discomfort and occurrence of vasovagal reactions but has not been shown to effect incidence of vasovagal reactions (Norman, 1998). Intravenous pain medication may be administered before sheath removal, but this is not routine practice. In 2007, a clinical trial (Roberts et al) using the Safeguard manual assist device during sheath femoral removal showed no higher complication rate than other methods of sheath removal, and patient/nurse comfort and satisfaction were high. These researchers seek to adopt the practice that provides better comfort and outcomes for the patient and the nurse.



Experimental design was used in this study.



Postcardiac catheterization patients will be randomly assigned to MAT/ Safeguard or FemoStop group (inclusion/exclusion criteria apply). Nurses caring for the patient will follow usual guidelines for timing of sheath removal and procedural guidelines for assigned assistive device. Data collectors will ask the patient permission to inquire and record (for purposes of the study) comfort level during the procedure within 4 hours after sheath removal. The nurse performing the sheath pull will also be queried regarding discomfort and satisfaction level (0-5 scales). Other variables will be noted (eg, type of anticoagulant used, total compression time).



Hypothesis: patients will experience less discomfort with MAT; nurses will report higher satisfaction scores with MAT (Safeguard) over FemoStop (pending data collection from up to 200 cases; expected analysis: January 2009).


Implications for Practice:

Anticipate the use of MAT/Safeguard with all "manual pulls" and in place of selected "Femostop pulls"; anticipate other areas to adopt Safeguard; and, overall, experience a decrease in repetitive use injury/severity.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.