“When’s dinner?” pleads my new patient, as the cardiac cath techs wheel him into the recovery unit. “I’ve had nothing since yesterday,” he adds. I’d love to bring him some prime rib and a glass of wine–but not at the expense of his life and my RN license.
But he’s too miserable to be overloaded with whys and wherefores. Like the fact that a coronary stent was just threaded up his femoral artery to his heart, through a sheath that’s still in his groin. Or that arteries hate foreign bodies in them, meaning it’s a race against the clock to get the sheath out before it causes a spasm or infection. I don’t want him to become unstable or to bleed to death, so I need to focus on a hundred things: monitoring his blood pressure, heart rate and cardiac rhythm. Feeling the pulses in his feet. Checking his oxygen and activated clotting times. Inspecting the puncture area in his upper thigh…
So I merely say, “I’m sorry, but you still have a sheath in your leg from the stent procedure, and we have to get that out first.”
The hospital trained me well to anticipate problems, and I’m confident in my ability to handle shock, chest pain, high or low blood pressure or bleeding. I’m not stressed about the clinical work. But my patient’s anxiety chips away inside me. I really wish I could bring him some food.
Within the hour, his clotting time drops from 200 to 140 seconds, which is therapeutic for sheath removal. I take it out and, using two fingertips, apply firm pressure on his artery. His skin is slippery with blood and sweat. One false move could allow blood to leak, forming a rock-hard, painful knot under his skin. It’d be easier to mash my fist into his groin, but such brute force leaves a nasty bruise and obscures the site.
Arteries are under high pressure and have tough elastic walls that bounce back like bucking broncos when you push on them. I hold steady with my entire body weight on his femoral pulse for five minutes, then ease up little by little over the next twenty minutes.
As soon as his groin site is clean, dry, and intact, I feel a sense of accomplishment and order his meal tray. When his cheeseburger arrives, we both can relax–even though he says, “This is the best hockey puck on a bun I’ve ever tasted.”