Arterial Femoral Sheath Removal Procedure

Patient Preparation and Assessment

The American Heart Association recommends verifying that coagulation parameters are appropriate before sheath removal, for patients who received heparin, wait until the activated clotting time (ACT) falls to 150-180 seconds or when the activated partial thromboplastin time falls to 50 seconds 1
Position the patient supine with the affected leg straight and immobilized, and ensure proper monitoring equipment is in place, including blood pressure monitoring and pulse oximetry 2
Consider placing an additional pulse oximeter on the foot of the affected leg to provide early warning of femoral artery obstruction or distal thromboembolism 2, 3

Gather necessary supplies, including sterile gloves, antiseptic solution, sterile gauze, compression device (if using), and appropriate dressings 2
Ensure emergency equipment is readily available in case of complications 2

Cleanse the puncture site with antiseptic solution 4
Apply manual pressure 2-3 cm proximal to the puncture site 2, 5
While maintaining proximal pressure, smoothly and steadily remove the sheath in a single motion along the angle of insertion 2
Gradually reduce pressure while monitoring for bleeding 2

Apply a sterile pressure dressing once hemostasis is achieved 2
Monitor vital signs and puncture site frequently for the first hour, then periodically for 24 hours 4
Assess distal pulses, color, temperature, and sensation of the affected limb regularly 2
Monitor for complications including hematoma, pseudoaneurysm, retroperitoneal bleeding, and arteriovenous fistula 4

Small asymptomatic pseudoaneurysms (<2.0 cm) may resolve spontaneously within 2 months and can be managed conservatively with follow-up ultrasound 4
Larger pseudoaneurysms (≥2.0 cm) that persist may require surgical intervention 4

Overly vigorous compression causing vessel occlusion can be avoided by monitoring distal pulses during compression 2, 3
Improper identification of puncture site can be avoided by using anatomical landmarks or ultrasound guidance to identify the common femoral artery 6
Failure to recognize complications early can be avoided by maintaining vigilant monitoring of the access site and distal circulation 4