Performance evaluation of arterial femoral sheath removal by registered nurses after PCI.

BACKGROUND

Sheath removal after PCI by registered nurses can improve patients' comfort and shorten immobilisation time. As sheath removal is not without risk, it is important to assure the quality of performance.

AIMS

The aim was (a) to check if nurses' performance in 1999 and 2005 was in accordance with the protocol for arterial sheath removal and (b) to compare both measurements to explore differences in performance over time.

METHODS

We trained registered nurses in sheath removal and observed them during sheath removal in elective uncomplicated PCI-patients. We developed and used a checklist, including 10 elements and 65 items.

RESULTS

Both in 1999 (n=43 observations with 13 nurses) and 2005 (n=42 observations with 16 nurses) the norm of more than 90% for the total score was not achieved: we found 82% and 80%, respectively. Four elements scored more than 90%, and three elements scored less than 80% at both points in time. The results on the other three elements differed significantly over time.

CONCLUSION

Registered nurses achieved the norm for good performance (80-89%) of removing arterial sheaths according to protocol after a training programme and this is stable in time. Since the norm for excellent performance (> or =90%) was not achieved, current performance could be improved, e.g. by yearly repetition of training and observation of skills. More research is needed, and could focus on the validation of the instrument. Also multi-centre studies with this checklist could test the association between the quality of arterial femoral sheath removal and the occurrence of vascular complications.