Post-CAG (Coronary Angiography) - Sheath Removal & Vasovagal Management

Key Concept: Atropine

• Atropine acts as a vasoconstrictor
• Vasovagal effect causes: ↓ BP, ↓ HR, ↓ Consciousness

After CAG - In Cath Lab Procedure

Why the Sheath is Kept In

• Sheath is kept in the patient after CAG
• Reason: the drug dose is still working, so the sheath is retained until blood returns to its normal state

Monitoring Before Removal

• Check: ↑ HR, ↑ BP (wait for values to come back up)

To Revert the Vasovagal Effect - Things to Have Ready:

1. Saline Bottle
2. Atropine
3. Standby Nurse

Sheath Removal Protocol

1. Shift patient to ICU
   • Check all parameters
   • Run Blood Tests
2. Wait ~30 minutes
3. Local Anaesthesia
   • Note: Psychological disorder can also trigger vasovagal response
4. Remove the Sheath
   • Allow a few drops of blood to come out
5. Compress the area for 5-10 minutes
   • Apply pressure above 2-3 inches from the insertion site, towards the direction of blood flow
6. Check if the area is completely sealed
   • Ask the patient to cough → this raises arterial pressure → causes bleeding if not sealed
   • This tests whether the site is fully closed

Complications if Not Sealed Properly

Internal Bleeding Risk

• If not sealed properly from inside → leads to internal bleeding

Aematoma (Haematoma) Formation

• Caused by internal thrombus formation
• Takes 24 hours to compress/resolve the area

Clinical Note: Always monitor for vasovagal responses post-sheath removal. Keep atropine and saline immediately accessible. Confirm arterial site closure with a cough test before clearing the patient.