Copies of MAR (medication administration record) with dates and times of meds received… including prn meds Please follow “Patient Transfer Checklist for Urgent Inpatient to HIU” When calling report to HIU… please follow “Template for Sending Units’ Report” “EMERGENCY” PATIENTS COMING TO HIU HIU HOTLINE (0700 – 2000 hours, Mon – Fri) 905-577-8007 Using the hotline will allow the referring physician to speak directly to one of HIU’s interventional cardiologist Using the algorithm provided on the HIU website or the “STEMI & NSTEMI algorithm” provided in the handbook, a referring physician can quickly determine the most appropriate steps for an emergency referral. Please fax patient’s ECG and referral form to 905-575-2649 If after hours (2000-0700 Mon.-Thurs), weekends or holidays: Please page the interventional cardiologist on call at: 905-521-2100 ext.46311
Femoral/Brachial *If arterial and venous sheaths are insitu at the SAME access site, remove arterial sheath FIRST *BRACHIAL ACCESS ONLY Ambulate according to physician order Sheath insitu Q 15 min X 4 Q 30 min until sheath removal Sheath Removal Follow Protocol Post sheath removal Q 15 min X 4 Q 30 min X 2 Q 1 hour X 4 (and/or prior to discharge) then Q 4 h Continuous ECG - Sheath insitu - During removal D/C ECG - 1.5 hours after sheath removal Bed rest - 3 hours post sheath removal/hemostasis, then ambulate - First ambulation with nurse HOB - Up to 30 degrees first two hours of bed rest - Up to 45 degrees after two hours - Lateral position acceptable [affected limb straight] - NO limitations for brachial Sterile band-aid Femoral Venous Access Only Sheath insitu Remove immediately Sheath Removal Follow protocol Post sheath removal Q 15 min X 2 Q 30 min X 2 (and/or prior to discharge) Continuous ECG - Sheath insitu - During removal D/C ECG Bed rest completed Bed rest - 30 minutes sheath removal/hemostasis, then ambulate - First ambulation with nurse HOB - Up to 45 degrees until first ambulation - Lateral position acceptable [affected limb straight] Sterile band-aid Closure Device Post sheath removal Q 15 min X 4 Q 30 min X 2 Q 1 hour X 4 (and/or prior to discharge) then Q 4 Continuous ECG - 1.5 hours after sheath removal Bed rest - 2 hours post device insertion, then ambulate - First ambulation with nurse HOB - Up to 45 degrees after one hour of bed rest Tegaderm Radial Clamp Radial Clamp insitu Q 15 min X 4 until first clamp release Clamp Removal Follow protocol Post Radial Clamp Removal Q 15 min X 2 Q 30 min X 1 (and/or prior to discharge) then Q 4 h Continuous ECG - Clamp insitu - During removal D/C ECG - 1.5 hours after sheath removal or upon first ambulation Bed rest - Until post clamp removal/hemostasis - Ambulate 15 min post hemostasis -First ambulation with nurse HOB - No restrictions Sterile band-aid Appendix: Vital Signs, Monitoring/Assessment and Management for Diagnostic Procedures & PCI Percutaneous Coronary Intervention (PCI)
Procedure Vital Signs ECG Bed rest/ HOB Elevated Dressing Femoral/Brachial *BRACHIAL ACCESS ONLY Ambulate according to physician order Sheath insitu Q 15 min X 4 Q 30 min until sheath removal Sheath Removal Follow Protocol Post sheath removal Q 15 min X 4 Q 30 min X 2 Q 1 hour X 4 (and/or prior to discharge) then Q 4 h Continuous ECG - Sheath insitu - During removal D/C ECG - After first ambulation Bed rest - 3 hours sheath removal/hemostasis, then ambulate - First ambulation with nurse HOB - Up to 30 degrees first two hours of bed rest - Up to 45 degrees after two hours - Lateral position acceptable [affected limb straight] - NO limitations for brachial Sterile band-aid Closure Device Post sheath removal Q 15 min X 4 Q 30 min X 2 Q 1 hour X 4 (and/or prior to discharge) then Q 4 h Continuous ECG While on bedrest D/C ECG - After first ambulation Bed rest - 2 hours post device insertion, then ambulate - First ambulation with nurse HOB - Up to 45 degrees after one hour of bed rest Tegaderm Radial Clamp Radial Clamp insitu Q 15 min X 4 until first clamp release Clamp Removal Follow protocol Post Radial Clamp Removal Q 15 min X 2 Q 30 min X 1 (and/or prior to discharge) then Q 4 h Continuous ECG - Clamp insitu - During removal D/C ECG - After first ambulation Bed rest - Until post clamp removal/hemostasis - Ambulate 15 min post hemostasis - First ambulation with nurse HOB - No restrictions Sterile band-aid Bleeding/Hematoma Management Algorithm – Before and After Sheath Removal