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What Could Possibly Go Wrong During a Simple Procedure?

What could possibly go wrong?…..Code Blue, Code Blue Room 2114……that’s what! Tragically, a simple procedure did go terribly wrong for Joan Rivers.


Motion Blur Stretcher Gurney Patient Hospital Emergency

Don’t let a simple procedure turn into an emergency

How to be prepared before you perform a procedure.

Before doing any procedure, it’s important to prepare for the worst that could happen. You don’t want to be taken by surprise- because that can lead to shock and paralysis on your part while your pt’s decompensating or coding.

Chaos ensues when a Procedure turns into an  Emergency. Where’s the suction? Oxygen? Backboard?

For example, think about pulling a femoral arterial sheath.

Sheath removal is generally done in Cath Lab after an angiogram/plasty, but occasionally is performed on the floors.

Even if you never pull a sheath, the principle of being prepared is the same for all procedures.

  • What can go wrong and
  • What will I do if it happens?

What’s the worst that could happen

Invariably when I ask new nurses: “What’s the worst that can happen during a sheath pull?”

The answer is: “Bleeding! Bleeding is the worst that can happen!!”  All present look at each other, nod sagely and agree.

Screen Shot 2014-09-29 at 7.34.42 AM

If only bleeding were the worst that could happen

To which I respond: “No! You are not yet ready for Sheath Pull Privileges!”~softening~”Yes, I set you up for that. But let’s look at it. How many patients in this hospital have died from bleeding during a Sheath Pull? None. That’s right. Zero.”

“Yes, bleeding is messy. Yes, it is scary if you can’t get the arterial bleed immediately under control. But 1) better an out and out bleed than a hematoma, and 2) back to the main question.”

The truth

[Tweet “The worst that can happen here is sudden cardiopulmonary arrest”] If the newly opened vessel clamps shut or clots off and the patient vagals and becomes increasingly hypotensive and the resulting ischemia leads to an MI..and… see where I’m going?”

Rehearse and prepare exactly how you will treat hypotension, bradycardia, chest pain, possible collapse. Oh, and bleeding. Do you have a viable IV site? IV fluid? Quick access to Atropine? Bedside monitor? Now gather your supplies and go. You’re ready, my friend.

Until next time,


About Beth Hawkes (146 Articles)
Nice to meet you! I'm a Nursing Professional Development Specialist in acute care, a writer, speaker and career columnist.

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